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Evans DW. Development and initial testing of a brief, generic self-reported disability questionnaire: The Universal Disability Index. PLoS One 2024; 19:e0303102. [PMID: 38718000 PMCID: PMC11078367 DOI: 10.1371/journal.pone.0303102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Disability is an important multifaceted construct. A brief, generic self-reported disability questionnaire that promises a broader and more comparable measure of disability than disease-specific instruments does not currently exist. The aim of this study was to develop and evaluate such a questionnaire: the Universal Disability Index (UDI). METHODS An online survey was used to collect general population data. Data were randomly divided into training and validation subsets. The dimensionality and structure of eight UDI questionnaire items were evaluated using exploratory factor analysis (EFA, training subset) followed by confirmatory factor analysis (CFA, validation subset). To assess concurrent validity, the UDI summed score from the full dataset was compared to the Groningen Activity Restriction Scale (GARS) and the Graded Chronic Pain Scale (GCPS) disability scores. Internal consistency and discriminant validity were also assessed. Bootstrapping was used to evaluate model stability and generalisability. RESULTS 403 participants enrolled; 364 completed at least one UDI item. Three single-factor versions of the UDI were assessed (8-item, 7-item, and 6-item). All versions performed well during EFA and CFA (182 cases assigned to each), but none met the RMSEA (Root Mean Square Error of Approximation) criterion (≤ 0.08). All versions of the UDI had high internal consistency (Cronbach's α > 0.90), were strongly correlated (Pearson's r > 0.7) with both GARS and GCPS disability scores, indicating concurrent validity, and could accurately discriminate between upper and lower quartiles of these comparators. Confidence intervals of estimates were narrow, suggesting model stability and generalisability. CONCLUSIONS A brief, generic self-reported disability questionnaire was found to be valid and to possess good psychometric properties. The UDI has a single factor structure and either a 6-item, 7-item or 8-item version can be used to measure disability. For brevity and parsimony, the 6-item UDI is recommended, but further testing of all versions is warranted.
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Affiliation(s)
- David William Evans
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- University College of Osteopathy, London, United Kingdom
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Bowman A, Denehy L, McDonald CE, Edbrooke L. "The Ability to Go Out into the World Is the Most Important Thing"-A Qualitative Study of Important Exercise Outcomes for People with Lung Cancer. Curr Oncol 2024; 31:733-746. [PMID: 38392048 PMCID: PMC10887680 DOI: 10.3390/curroncol31020054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/20/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
Whilst existing quantitative research identifies outcomes believed to be important by researchers and clinicians, it may neglect outcomes that are meaningful to patients. This study aimed to explore the outcomes of exercise that are important to people with lung cancer and their carers. Data collection involved a qualitative methodology including semi-structured interviews and focus groups. Question guide development was informed by the International Classification of Functioning (ICF) framework. Data were analyzed by two researchers with NVivo (v12) software using a conventional content analysis process, followed by directed content analysis to map outcomes to the ICF. Conduct and reporting adhered to COREQ guidelines. Fifteen participants provided data. Most participants had received their diagnoses 24 months prior to study involvement (n = 9), and one-third had completed treatment (n = 5). Important outcomes were reported by participants across all domains of the ICF: activity and participation (n = 24), body function (n = 19), body structure (n = 5), environmental factors (n = 5), and personal factors (n = 1). Additional code categories pertained to the impacts of non-cancer factors such as age, frailty, and comorbidities; identifying barriers to exercise; and individualizing outcome measures. Clinicians and researchers should consider selecting outcomes from all relevant domains of the ICF, with a focus on the activity and participation domain, in addition to non-cancer factors such as ageing, frailty, and co-morbidities. Feedback should be provided to patients following outcome measures collection and reassessment.
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Affiliation(s)
- Amy Bowman
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC 3053, Australia; (A.B.); (L.D.); (C.E.M.)
- Department of Physiotherapy, Peter Mac Callum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC 3053, Australia; (A.B.); (L.D.); (C.E.M.)
- Department of Health Services Research, Peter Mac Callum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Cassie E. McDonald
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC 3053, Australia; (A.B.); (L.D.); (C.E.M.)
- Allied Health, Alfred Health, Melbourne, VIC 3004, Australia
| | - Lara Edbrooke
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC 3053, Australia; (A.B.); (L.D.); (C.E.M.)
- Department of Health Services Research, Peter Mac Callum Cancer Centre, Melbourne, VIC 3000, Australia
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Bevers MSAM, Heyer FL, Wyers CE, van Rietbergen B, Geusens PPMM, Janzing HMJ, Lambers Heerspink O, Poeze M, van den Bergh JP. The contribution of lower-mineralized tissue to the healing of distal radius fractures assessed using HR-pQCT. Bone 2023; 175:116859. [PMID: 37507063 DOI: 10.1016/j.bone.2023.116859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/03/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023]
Abstract
High-resolution peripheral quantitative CT (HR-pQCT) enables quantitative assessment of distal radius fracture healing. In previous studies, lower-mineralized tissue formation was observed on HR-pQCT scans, starting early during healing, but the contribution of this tissue to the stiffness of distal radius fractures is unknown. Therefore, the aim of this study was to investigate the contribution of lower-mineralized tissue to the stiffness of fractured distal radii during the first twelve weeks of healing. We did so by combining the results from two series of micro-finite element (μFE-) models obtained using different density thresholds for bone segmentation. Forty-five postmenopausal women with a conservatively-treated distal radius fracture had HR-pQCT scans of their fractured radius at baseline (BL; 1-2 weeks post-fracture), 3-4 weeks, 6-8 weeks, and 12 weeks post-fracture. Compression stiffness (S) was computed using two series of μFE-models from the scans: one series (Msingle) included only higher-mineralized tissue (>320 mg HA/cm3), and one series (Mdual) differentiated between lower-mineralized tissue (200-320 mg HA/cm3) and higher-mineralized tissue. μFE-elements were assigned a Young's Modulus of 10 GPa (higher-mineralized tissue) or 5 GPa (lower-mineralized tissue), and an axial compression test to 1 % strain was simulated. The contribution of the lower-mineralized tissue to S was quantified as the ratio Sdual/Ssingle. Changes during healing were quantified using linear mixed effects models and expressed as estimated marginal means (EMMs) with 95 %-confidence intervals (95 %-CI). Median time to cast removal was 5.0 (IQR: 1.1) weeks. Sdual and Ssingle gradually increased during healing to a significantly higher value than BL at 12 weeks post-fracture (both p < 0.0001). In contrast, Sdual/Ssingle was significantly higher than BL at 3-4 weeks post-fracture (p = 0.0010), remained significantly higher at 6-8 weeks post-fracture (p < 0.0001), and then decreased to BL-values at the 12-week visit. EMMs ranged between 1.05 (95 %-CI: 1.04-1.06) and 1.08 (95 %-CI: 1.07-1.10). To conclude, combining stiffness results from two series of μFE-models obtained using single- and dual-threshold segmentation enables quantification of the contribution of lower-mineralized tissue to the stiffness of distal radius fractures during healing. This contribution is minor but changes significantly around the time of cast removal. Its course and timing during healing may be clinically relevant. Quantification of the contribution of lower-mineralized tissue to stiffness gives a more complete impression of strength recovery post-fracture than the evaluation of stiffness using a single series of μFE-models.
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Affiliation(s)
- Melissa S A M Bevers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Frans L Heyer
- NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Surgery, VieCuri Medical Center, Venlo, the Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Piet P M M Geusens
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Medicine and Life Sciences, Hasselt University, Belgium
| | | | | | - Martijn Poeze
- NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Surgery and Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands.
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Farzad M, MacDermid J, Hemmati M, Farhoud AR. Occupational Performance 1 Year After a Distal Radius Fracture From the Perspective of the International Classification of Functioning, Disability and Health. Am J Occup Ther 2023; 77:7705205040. [PMID: 37793017 DOI: 10.5014/ajot.2023.050180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
IMPORTANCE Distal radius fractures (DRFs) frequently compromise independent functioning. OBJECTIVE To analyze occupational performance post-DRF using the Canadian Occupational Performance Measure (COPM) and related interviews, guided by the International Classification of Functioning, Disability and Health (ICF). COPM score was compared with standard metrics: Patient-Reported Wrist Evaluation (PRWE) and Participation Behavior Questionnaire (PBQ). METHOD Through a semistructured COPM interview, participants highlighted self-care, productivity, and leisure. They completed the PRWE and PBQ, linking results to ICF sets. DESIGN Prospective cohort. SETTING Outpatient hand surgery clinic at a trauma center. PARTICIPANTS Patients (N = 120), 1 yr post-DRF. OUTCOMES AND MEASURES Incorporated COPM, PRWE, and PBQ, linked to ICF. RESULTS Analysis identified 73 codes, aligning with 30 ICF Hand Conditions codes. Main concerns related to self-care (15.21%), leisure (12.16%), and productivity (16.22%). Major challenges pertained to domestic (67.00%) and civic life (64.53%) within ICF. Occupational performance was positively correlated with participation (r = .62) and inversely with disability (r = -.62). CONCLUSIONS AND RELEVANCE DRFs result in varied occupational challenges that are not always reflected in standard measures. The COPM offers a comprehensive insight into post-DRF patient challenges, emphasizing the value of diverse clinical assessment approaches. What This Article Adds: This study highlights the importance of a holistic approach in occupational therapy for DRF patients, revealing that standard measurements might overlook key challenges that they face. By adopting broader evaluative methods, occupational therapists can better address patient-specific needs and enhance their rehabilitation outcomes.
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Affiliation(s)
- Maryam Farzad
- Maryam Farzad, PhD, MSc, BSc, is Postdoctoral Associate, School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada, and Assistant Professor, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran;
| | - Joy MacDermid
- Joy MacDermid, PhD, MSc, BSc, is Professor, Department of Physical Therapy and Surgery, Western University, London, Ontario, Canada; Codirector, Clinical Research Laboratory, Hand and Upper Limb Center, St. Joseph's Health Center, London, Ontario, Canada; and Professor, Department of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Motahar Hemmati
- Motahar Hemmati, BSc OT, is Master's Student, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Amir Reza Farhoud
- Amir Reza Farhoud, MD, is Assistant Professor, Department of Orthopedic Surgery, Imam Hospital Complex, Tehran University of Medical Sciences, Joint Reconstruction Research Center, Tehran, Iran
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Boel S, Vinther A, Hansen AØ, Juhl CB, Landgren M, Jacobsen NS, Paulsen CP, Jørgensen CT, Kristensen HK. Factors influencing functioning after volar locking plate fixation of distal radius fractures: a scoping review of 148 studies. Acta Orthop 2023; 94:280-286. [PMID: 37293983 PMCID: PMC10253938 DOI: 10.2340/17453674.2023.13431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/23/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND AND PURPOSE A better understanding of factors that influence functioning may improve the identification of patients with distal radius fractures (DRFs) who need hand therapy. The purpose of this scoping review was to provide a comprehensive overview of factors that have been evaluated for their influence on hand functioning following volar plate fixation of DRFs. MATERIAL AND METHODS 6 databases were searched from 2005 to 2021 for publications regarding surgical treatment for a DRF with a volar locking plate. Included studies evaluated demographic, perioperative, and postoperative factors within the 6 weeks post-surgery for their influence on functioning at least 3 months post-surgery. Functioning was assessed with patient-reported outcome measures. The factors were categorized into themes and mapped to the International Classification of Functioning, Disability and Health (ICF). RESULTS 148 studies were included. 708 factors were categorized into 39 themes (e.g. pain) and mapped to the ICF components. The themes were primarily mapped to "body functions and structures" (n = 26) and rarely to "activities and participation" (n = 5). Fracture type (n = 40), age (n = 38), and sex (n = 22) were the most frequently evaluated factors. CONCLUSION This scoping review identified an extensive number of factors evaluated within 6 weeks after surgery for their influence on functioning at least 3 months after volar plate fixation of a DRF and the existing research has primarily evaluated factors related to "body functions and structures," with limited focus on factors related to "activities and participation."
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Affiliation(s)
- Susanne Boel
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte; Department of Clinical Research, University of Southern Denmark, Odense; Centre for Innovative Medical Technology, Odense University Hospital, Odense.
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte; Hospital Secretariat and Communications, Research, Herlev and Gentofte, Copenhagen University Hospital
| | - Alice Ø Hansen
- Department of Clinical Research, University of Southern Denmark, Odense; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense
| | - Carsten B Juhl
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense
| | - Marcus Landgren
- Department of Orthopedic Surgery, Hand Surgery Unit, Herlev and Gentofte, Copenhagen University Hospital; Department of Evidence-Based Medicine (EBM), Danish Health Authority, Copenhagen
| | - Nicolaj S Jacobsen
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense
| | - Camilla P Paulsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | | | - Hanne Kaae Kristensen
- Department of Clinical Research, University of Southern Denmark, Odense; Centre for Innovative Medical Technology, Odense University Hospital, Odense; Health Sciences Research Centre, UCL University College, Odense, Denmark
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Thorninger R, Wæver D, Tjørnild M, Lind M, Rölfing JD. Prospective Evaluation of Two Cohorts of Non-Operatively Treated Patients with Displaced vs. Minimally and Non-Displaced Distal Radius Fractures. J Clin Med 2023; 12. [PMID: 36902861 DOI: 10.3390/jcm12052076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/01/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Distal radius fractures (DRFs) in the elderly are common. Recently, the efficacy of operative treatment of displaced DRFs in patients above 65 years of age has been questioned and it has been suggested that non-operative treatment should be the gold standard. However, the complications and functional outcome of displaced vs. minimally and non-displaced DRFs in the elderly has not been evaluated yet. The aim of the present study was to compare non-operatively treated displaced DRFs vs. minimally and non-displaced DRFs in terms of complications, PROMs, grip strength and range of motion (ROM) after 2 weeks, 5 weeks, 6 months and 12 months. METHODS We used a prospective cohort study that compared patients with displaced DRFs (n = 50), i.e., >10 degrees of dorsal angulation after two reduction attempts, with patients with minimally or non-displaced DRFs after reduction. Both cohorts received the same treatment of 5 weeks of dorsal plaster casting. Complications and functional outcomes (quick disabilities of the arm, shoulder and hand (QuickDASH), patient-rated wrist/hand evaluation (PRWHE), grip strength and EQ-5D scores) were assessed after 5 weeks, 6 months and 12 months post-injury. The protocol of the VOLCON RCT and present observational study has been published (PMC6599306; clinicaltrials.gov: NCT03716661). RESULTS One year after 5 weeks of dorsal below-elbow casting of low-energy DRFs in patients ≥ 65 years old, we found a complication rate of 6.3% (3/48) in minimally or non-displaced DRFs and 16.6% (7/42) in displaced DRFs (p = 0.18). However, no statistically significant difference was observed in functional outcomes in terms of QuickDASH, pain, ROM, grip strength or EQ-5D scores. DISCUSSION In patients above 65 years of age, non-operative treatment, i.e., closed reduction and dorsal casting for 5 weeks, yielded similar complication rates and functional outcomes after 1 year regardless of whether the initial fracture was non-displaced/minimally displaced or still displaced after closed reduction. While the initial closed reduction should still be attempted in order to restore the anatomy, failure to achieve the stipulated radiological criteria may not be as important as we thought in terms of complications and functional outcome.
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Deshmukh SR, Kirkham JJ, Karantana A. Developing a core outcome set for hand fractures and joint injuries in adults. Bone Jt Open 2023; 4:87-95. [PMID: 37051848 PMCID: PMC9999122 DOI: 10.1302/2633-1462.42.bjo-2022-0105.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
AimsThe aim of this study was to develop a core outcome set of what to measure in all future clinical research on hand fractures and joint injuries in adults.MethodsPhase 1 consisted of steps to identify potential outcome domains through systematic review of published studies, and exploration of the patient perspective through qualitative research, consisting of 25 semi-structured interviews and five focus groups. Phase 2 involved key stakeholder groups (patients, hand surgeons, and hand therapists) prioritizing the outcome domains via a three-round international Delphi survey, with a final consensus meeting to agree the final core outcome set.ResultsThe systematic review of 160 studies identified 74 outcome domains based on the World Health Organization International Classification of Functioning, Disability, and Health. Overall, 35 domains were generated through thematic analysis of the patient interviews and focus groups. The domains from these elements were synthesised to develop 37 outcome domains as the basis of the Delphi survey, with a further four generated from participant suggestions in Round 1. The Delphi survey identified 20 outcome domains as ‘very important’ for the core outcome set. At the consensus meeting, 27 participants from key stakeholder groups selected seven outcomes for the core outcome set: pain/discomfort with activity, pain/discomfort with rest, fine hand use/dexterity, self-hygiene/personal care, return to usual work/job, range of motion, and patient satisfaction with outcome/result.ConclusionThis set of core outcome domains is recommended as a minimum to be reported in all clinical research on hand fractures and joint injuries in adults. While this establishes what to measure, future work will focus on determining how best to measure these outcomes. By adopting this patient-centred core outcome set, consistency and comparability of studies will be improved, aiding meta-analysis and strengthening the evidence base for management of these common and impactful injuries.Cite this article: Bone Jt Open 2023;4(2):87–95.
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Affiliation(s)
- Sandeep R. Deshmukh
- Centre for Evidence Based Hand Surgery, University of Nottingham, Nottingham, UK
| | - Jamie J. Kirkham
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Alexia Karantana
- Centre for Evidence Based Hand Surgery, University of Nottingham, Nottingham, UK
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Pérez-Úbeda MJ, Urbina-Balanz A, Rizo B, Collado-Gosálvez A, Gimeno MD, Marco-Martinez F. Association Between Hounsfield Units in Preoperative Wrist Computed Tomography Scans and Outcomes After Wrist Fracture Surgery. Indian J Orthop 2022; 56:2141-2152. [PMID: 36507200 PMCID: PMC9705644 DOI: 10.1007/s43465-022-00749-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/07/2022] [Indexed: 02/04/2023]
Abstract
Purpose This work aims to evaluate the hypothesis that the value of Hounsfield units (HU), as a marker of bone density, in preoperative wrist computed tomography (CT) scans correlates with the functional outcomes as measured by patient reported outcomes (PROs) after distal radius fracture surgery with volar locking plate fixation. Methods Of a database of 92 wrist fractures operated on in our hospital between 2011 and 2020, with a preoperative CT scan performed, we selected the cases with a minimum follow-up period of 12 months. After applying the exclusion criteria, the final cohort comprised 64 patients. Three measurements of HU were performed in correlative coronal sections of the capitate bone. PROs were determined using two functional questionnaires (DASH and PRWE) and one quality of life questionnaire (SF-12). The statistical relationship between PROs and the HU measurements obtained via a CT scan was analyzed. Results Patients were classified into two groups, osteoporotic (OST) or non-osteoporotic (non-OST), according to the optimal cut-off value of 323 HU selected using a ROC curve. The median DASH questionnaire score in the OST group was significantly higher (1.7 vs 10.0, p = 0.003). Conclusion HU values in preoperative wrist CT scans may help to identify osteoporotic bone in patients prior to wrist fracture surgery and lead to an improved surgical indication and treatment strategy. Level of Evidence Level of evidence: Prognostic III.
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Affiliation(s)
- María-José Pérez-Úbeda
- Hand and Wrist Surgery Unit, Orthopedic Surgery and Traumatology, Department, San Carlos Clinical Hospital, 5ª Planta, Ala Sur. Calle Profesor Martín Lagos S/N, 28004 Madrid, Spain
| | | | - Belén Rizo
- Hand and Wrist Surgery Unit, Orthopedic Surgery and Traumatology, Department, San Carlos Clinical Hospital, 5ª Planta, Ala Sur. Calle Profesor Martín Lagos S/N, 28004 Madrid, Spain
| | - Alicia Collado-Gosálvez
- Hand and Wrist Surgery Unit, Orthopedic Surgery and Traumatology, Department, San Carlos Clinical Hospital, 5ª Planta, Ala Sur. Calle Profesor Martín Lagos S/N, 28004 Madrid, Spain
| | - María-Dolores Gimeno
- Hand and Wrist Surgery Unit, Orthopedic Surgery and Traumatology, Department, San Carlos Clinical Hospital, 5ª Planta, Ala Sur. Calle Profesor Martín Lagos S/N, 28004 Madrid, Spain
| | - Fernando Marco-Martinez
- Hand and Wrist Surgery Unit, Orthopedic Surgery and Traumatology, Department, San Carlos Clinical Hospital, 5ª Planta, Ala Sur. Calle Profesor Martín Lagos S/N, 28004 Madrid, Spain
- Surgery Department, Complutense University of Madrid, Madrid, Spain
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Fogel N, Mertz K, Shapiro LM, Roe A, Denduluri S, Kamal RN. Outcome Metrics in the Treatment of Distal Radius Fractures in Patients Aged Above 50 Years: A Systematic Review. Hand (N Y) 2022; 17:43S-49S. [PMID: 34286628 PMCID: PMC9793608 DOI: 10.1177/15589447211028919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The inclusion of patient-reported outcome measures (PROMs) serves to better quantify aspects of patient outcomes missed with objective measures, including radiographic indices and physical examination findings. We hypothesize that PROMs are inconsistently and heterogeneously captured in the treatment of distal radius fractures. METHODS We performed a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines of all level I and II randomized controlled trials (RCTs) of distal radius fracture treatment of any modality for those older than 50 years of age from January 2008 to January 2018. A total of 23 studies were included in the final analysis. The metrics used by each study to assess outcomes were collected, compared, and described. RESULTS Physical examination findings and radiographic measures were reported in 70% and 74% of studies, respectively. Patient-reported outcomes measures were used to assess outcomes in 74% of studies. Only the Disabilities of the Arm, Shoulder, and Hand was used in greater than half of the studies (57%). Pain scores were assessed in 39% of studies and complications in only 26%. CONCLUSIONS There is substantial heterogeneity and lack of standardization in the collection of both objective outcome measures and PROMs in level I and II RCTs for the treatment of distal radius fractures. The ability to compare between studies or aggregate data among studies is therefore limited. Radiographic and physical examination findings remain frequently reported despite known limitations of these metrics. The routine collection of PROMs after the treatment of distal radius fractures can ensure care is directed toward improving what is most important to patients.
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Affiliation(s)
| | - Kevin Mertz
- University of Southern California, Los
Angeles, USA
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Pearson NA, Tutton E, Joeris A, Gwilym SE, Grant R, Keene DJ, Haywood KL. A systematic review of outcome reporting in clinical trials of distal tibia and ankle fractures. Bone Jt Open 2022; 3:832-840. [DOI: 10.1302/2633-1462.310.bjo-2022-0080.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aims To describe outcome reporting variation and trends in non-pharmacological randomized clinical trials (RCTs) of distal tibia and/or ankle fractures. Methods Five electronic databases and three clinical trial registries were searched (January 2000 to February 2022). Trials including patients with distal tibia and/or ankle fractures without concomitant injuries were included. One reviewer conducted all searches, screened titles and abstracts, assessed eligibility, and completed data extraction; a random 10% subset were independently assessed and extracted by a second reviewer at each stage. All extracted outcomes were mapped to a modified version of the International Classification of Functioning, Disability and Health framework. The quality of outcome reporting (reproducibility) was assessed. Results Overall, 105 trials (n = 16 to 669 participants) from 27 countries were included. Trials compared surgical interventions (n = 62), post-surgical management options (n = 17), rehabilitative interventions (n = 14), surgical versus non-surgical interventions (n = 6), and pre-surgical management strategies (n = 5). In total, 888 outcome assessments were reported across seven domains: 263 assessed body structure or function (85.7% of trials), 136 activities (68.6% of trials), 34 participation (23.8% of trials), 159 health-related quality of life (61.9% of trials), 247 processes of care (80% of trials), 21 patient experiences (15.2% of trials), and 28 economic impact (8.6% of trials). From these, 337 discrete outcomes were described. Outcome reporting was inconsistent across trials. The quality of reporting varied widely (reproducibility ranged 4.8% patient experience to 100% complications). Conclusion Substantial heterogeneity in outcome selection, assessment methods, and reporting quality were described. Despite the large number of outcomes, few are reported across multiple trials. Most outcomes are clinically focused, with little attention to the long-term consequences important to patients. Poor reporting quality reduces confidence in data quality, inhibiting data synthesis by which to inform care decisions. Outcome reporting guidance and standardization, which captures the outcomes that matter to multiple stakeholders, are urgently required. Cite this article: Bone Jt Open 2022;3(10):832–840.
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Affiliation(s)
- Nathan A. Pearson
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Elizabeth Tutton
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Kadoorie Centre, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Services, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Stephen E. Gwilym
- Kadoorie Centre, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Services, University of Oxford, Oxford, UK
| | - Richard Grant
- National Institute for Health Research, Applied Research Collaboration, West Midlands, Warwick Medical School, University of Warwick, Coventry, UK
- Musculoskeletal Patient and Public Involvement Group, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Services, University of Oxford, Oxford, UK
- Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - David J. Keene
- Kadoorie Centre, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Services, University of Oxford, Oxford, UK
| | - Kirstie L. Haywood
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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MacDermid JC, Walton DM. Development and validation of the ND10 to measure neck-related functional disability. BMC Musculoskelet Disord 2022; 23:605. [PMID: 35739498 PMCID: PMC9219202 DOI: 10.1186/s12891-022-05556-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Previous neck-specific patient-reported outcome measures (PROMs) have tended to measure both symptoms and disability. This multi-staged study developed and evaluated a neck-specific PROM focusing on functional disability. Methods This study integrated findings from systematic reviews on neck-specific outcome measures, patient interviews, qualitative studies on neck disability, and iterative item testing to develop a 10-item measure of neck-related disability (ND10). Content validity was assessed by classifying items using the International Classification of Functioning, Disability and Health (ICF) and perspective linking. Patients (n = 78) with neck pain completed cognitive interviews, exploring items of the Neck Disability Index (NDI) and ND10, and completed structured questions related to literacy and relevance. Test–retest reliability and internal consistency were evaluated using intraclass correlation coefficients, Bland Altman graphs, and Cronbach’s alpha. Concurrent convergent validity was evaluated by comparing the ND10 to the NDI, Single Assessment Numeric Evaluation (SANE), and Disabilities of the Arm, Shoulder and Hand (DASH). Known group validity was determined by comparing ND10 scores from patients, who rated their neck as more or less than 1/2 of “normal” on the SANE, using t-tests. Results The ND10 requires respondents to make rational judgements about their neck-related body function and disability. It has high internal consistency (0.94) and re-test reliability (0.87; SEM = 3.2/100; MDC = 7.5); and no re-test bias (mean re-test difference of 0.6). It followed expected correlation patterns, being highly correlated with related multi-item PROMs (r = 0.85–0.91), and moderately correlated to the single-item SANE. More patients agreed that the ND10 was easily readable than did so for the NDI (84% vs 68%; p < 0.05). All the PROMs distinguished the patients who perceived themselves as being abnormal/normal defined by a dichotomized SANE (p < 0.01). Conclusion The ND10 is reliable and valid for measuring neck-related functional disability. Longitudinal and cross-cultural translation studies are needed to support future use. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05556-7.
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Affiliation(s)
- Joy C MacDermid
- Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, 268 Grosvenor Street, London, ON, N6A 4V2, Canada. .,School of Physical Therapy, Western University, London, ON, Canada.
| | - David M Walton
- School of Physical Therapy, Western University, London, ON, Canada
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Vanhala A, Lehto AR, Maksimow A, Torkki P, Kivivuori SM. Classifying outcomes in secondary and tertiary care clinical quality registries-an organizational case study with the COMET taxonomy. BMC Health Serv Res 2022; 22:806. [PMID: 35729629 PMCID: PMC9215071 DOI: 10.1186/s12913-022-08132-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The choice of what patient outcomes are included in clinical quality registries is crucial for comparable and relevant data collection. Ideally, a uniform outcome framework could be used to classify the outcomes included in registries, steer the development of outcome measurement, and ultimately enable better patient care through benchmarking and registry research. The aim of this study was to compare clinical quality registry outcomes against the COMET taxonomy to assess its suitability in the registry context. METHODS We conducted an organizational case study that included outcomes from 63 somatic clinical quality registries in use at HUS Helsinki University Hospital, Finland. Outcomes were extracted and classified according to the COMET taxonomy and the suitability of the taxonomy was assessed. RESULTS HUS clinical quality registries showed great variation in outcome domains and in number of measures. Physiological outcomes were present in 98%, resource use in all, and functioning domains in 62% of the registries. Patient-reported outcome measures were found in 48% of the registries. CONCLUSIONS The COMET taxonomy was found to be mostly suitable for classifying the choice of outcomes in clinical quality registries, but improvements are suggested. HUS Helsinki University Hospital clinical quality registries exist at different maturity levels, showing room for improvement in life impact outcomes and in outcome prioritization. This article offers an example of classifying the choice of outcomes included in clinical quality registries and a comparison point for other registry evaluators.
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Affiliation(s)
- Antero Vanhala
- Department of Public Health, Faculty of Medicine, University of Helsinki, P.O. Box 20, 00014, Helsinki, Finland.
| | - Anna-Rosa Lehto
- Department of Information Service and Management, Aalto University School of Business, Espoo, Finland
| | - Anu Maksimow
- HUS Helsinki University Hospital, P.O. Box 100, 00029 HUS, Helsinki, Finland
| | - Paulus Torkki
- Department of Public Health, Faculty of Medicine, University of Helsinki, P.O. Box 20, 00014, Helsinki, Finland
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Boel S, Vinther A, Hansen AØ, Juhl CB, Landgren M, Kristensen HK. Factors influencing self-perceived functioning after volar locking plate fixation of distal radius fractures: a scoping review protocol. JBI Evid Synth 2022; 20:2387-2394. [DOI: 10.11124/jbies-21-00459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Südow H, Severin S, Wilcke M, Saving J, Sköldenberg O, Navarro CM. Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years - a three year follow-up of a randomized controlled trial. BMC Musculoskelet Disord 2022; 23:447. [PMID: 35549696 PMCID: PMC9097389 DOI: 10.1186/s12891-022-05394-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/03/2022] [Indexed: 02/02/2023] Open
Abstract
Background Surgical treatment of displaced distal radius fractures (DRF) in older patients has increased, despite lacking evidence of its superiority over non-operative treatment. How treatment choice affects these patients after the initial 12-month period remains unknown. This study presents a clinical and radiographic follow up at an average of 3 years after treatment in the context of a randomized clinical trial comparing outcomes in patients aged ≥70 years, with a dorsally displaced distal radius fracture treated either surgically with volar locking plate or non-operatively. Methods Between 2009 and 2017, 140 patients aged ≥70 years with dorsally displaced DRF were randomized to surgery with volar locking plate (VLP) or non-operative treatment. At an average of 3 years after inclusion the participants were invited to an additional follow-up. The primary outcome was Patient Rated Wrist Evaluation (PRWE). Secondary outcomes included additional Patient Reported Outcome Measures (PROM), grip strength, range of motion, complications and radiological results. Results Sixty six patients were available for a 3 year follow-up, 33 in the non-operatively treated group and 33 in the VLP-group. The mean age at injury was 77 years. At 3 years the median PRWE was better (0 points) in the VLP-group than in the non-operative treatment group (9 points) p-value: 0.027. No statistically significant difference was found in Disabilities of the Arm, Hand, and Shoulder (DASH), EuroQol 5 Dimensions (EQ-5D) or grip strength. Total arc of range of motion was larger in the operatively treated group. No significant difference in osteoarthritis was found. Both groups had regained grip strength. The complication rate was similar. Outcomes improved from the 1 year to the 3 year follow-up. Conclusions Surgery with volar locking plate gave less long-term disability compared to non-operative treatment for severely displaced distal radius fractures in patients aged ≥70 years. Our findings were statistically significant but in the lower range of clinical importance. Trial registration The study was registered at : NCT02154620 03/06/2014 and NCT01268397 30/12/2010. Ethical approval was obtained from Ethical Committee in Stockholm, Sweden (2009/37–31/3, 2013/105–31/2, 2014/1041–32, 2017/611–32).
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Affiliation(s)
- Hanna Südow
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, SE-118 83, Stockholm, Sweden. .,Department of Orthopedics, Södersjukhuset Hospital, Stockholm, Sweden.
| | - Sara Severin
- Karolinska Institute, Department of Clinical Science, Danderyd Hospital, Stockholm, Sweden.,Department of Orthopedics, Danderyd University Hospital Corp, Stockholm, Sweden
| | - Maria Wilcke
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, SE-118 83, Stockholm, Sweden.,Department of Hand Surgery, Södersjukhuset Hospital, Stockholm, Sweden
| | - Jenny Saving
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, SE-118 83, Stockholm, Sweden.,Capio Artro Clinic, Stockholm, Sweden
| | - Olof Sköldenberg
- Karolinska Institute, Department of Clinical Science, Danderyd Hospital, Stockholm, Sweden.,Department of Orthopedics, Danderyd University Hospital Corp, Stockholm, Sweden
| | - Cecilia Mellstrand Navarro
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, SE-118 83, Stockholm, Sweden.,Department of Hand Surgery, Södersjukhuset Hospital, Stockholm, Sweden
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15
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Korbus H, Schott N. Does mental practice or mirror therapy help prevent functional loss after distal radius fracture? A randomized controlled trial. J Hand Ther 2022; 35:86-96. [PMID: 33308929 DOI: 10.1016/j.jht.2020.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A randomized, single-blinded controlled trial. INTRODUCTION Therapy results after distal radius fractures (DRF) especially with older patients are often suboptimal. One possible approach for counteracting the problems are motor-cognitive training interventions such as Mental Practice (MP) or Mirror Therapy (MT), which may be applied in early rehabilitation without stressing the injured wrist. PURPOSE OF THE STUDY The aim of the study is to investigate the effects of MP and MT on wrist function after DRF. The pilot study should furthermore provide information about the feasibility of these methods. METHODS Thirty-one women were assigned either to one of the two experimental groups (MP, MT) or to a control group (relaxation intervention). The participants completed a training for six weeks, administered at their homes. Measurements were taken at four times (weeks 0, 3, 6 and 12) to document the progression in subjective function (PRWE, QuickDASH) and objective constraints of the wrist (ROM, grip strength) as well as in health-related quality of life (EQ-5D). RESULTS The results indicated that both experimental groups showed higher improvements across the intervention period compared to the control group; e.g. PRWE: MT 74.0%, MP 66.2%, CG 56.9%. While improvements in grip strength were higher for the MP group, the MT group performed better in all other measures. However, time by group interactions approached significance at best; e.g. ROM: P = .076; ηp2 = .141. CONCLUSION The superiority of MP as well as MT supports the simulation theory. Motor-cognitive intervention programs are feasible and promising therapy supplements, which may be applied in early rehabilitation to counteract the consequences of immobilization without stressing the injured wrist.
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Keene DJ, Srikesavan C, Achten J, Tutton E, Dutton SJ, Marian IR, Grant R, Gould J, Herbert K, Athwal A, Appelbe D, Lamb SE, Costa ML. Flexibility and resistance exercises versus usual care for improving pain and function after distal radius fracture in adults aged 50 years or over: protocol for the WISE randomised multicentre feasibility trial. Pilot Feasibility Stud 2022; 8:55. [PMID: 35256000 PMCID: PMC8898994 DOI: 10.1186/s40814-022-01011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background Distal radius fractures represent about 1 in 5 of all fractures treated in UK hospitals. Most distal radius fractures occur in women aged 50 years or over after a fall. Distal radius fractures are managed using splints or casting, some are also treated with surgical fixation. Patients often experience long-term muscle weakness of the hand and arm that may impact their ability to do daily activities such as personal hygiene, routine household chores and food preparation. We propose a structured and tailored flexibility and resistance exercise programme for the hand and arm supplemented with behaviour change strategies to help perform daily exercise. The main aim of our study is to assess the feasibility of conducting a definitive randomised controlled trial. Methods This study is a multicentre, parallel-group individually randomised feasibility trial. We will recruit a minimum of 72 adults aged 50 years or over with distal radius fracture treated surgically or non-surgically from at least three UK National Health Service (NHS) hospitals. They will be randomised 1:1:1 to receive usual care, usual care and independent exercise with a single therapy session or usual care and supervised exercise with three therapy sessions over 12 weeks. Our primary feasibility objectives are (1) patient engagement assessed by recruitment, (2) acceptability of the interventions assessed by adherence and patient and clinician experience and (3) retention of participants in the trial. Outcome measures will be assessed at baseline, 3 months and at 6 months after randomisation. A qualitative sub-study will explore the experiences of the trial participants and therapists delivering the exercises. Discussion A definitive trial will be considered feasible without major modifications if our progression criteria are met. If successful, the findings will inform the design of a future definitive RCT to evaluate the clinical and cost-effectiveness of the WISE exercise programme. Trial registration ISRCTN12290145.
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Saka N, Hoshika S, Inoue M, Watanabe J, Banno M. Below- or above-elbow immobilization in conservative treatment of distal radius fractures: a systematic review and meta-analysis. Injury 2022; 53:250-258. [PMID: 34961625 DOI: 10.1016/j.injury.2021.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is no consensus regarding the range of immobilization in the conservative treatment of distal radius fractures (DRFs). Therefore, this systematic review and meta-analysis aimed to compare the clinical outcome of patients with DRFs treated conservatively with below- or above-elbow immobilization. MATERIALS AND METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, two independent reviewers searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov and World Health Organization International Clinical Trials Registry Platform in April 2020; a subsequent update search was conducted in April 2021. We identified all randomised controlled trials comparing two immobilization methods in DRFs. The primary outcome measures were the Disabilities of the Arm, Shoulder and Hand (DASH) or QuickDASH questionnaire scores in the short- and long-term (≤ and >six weeks, respectively) follow-up as well as the treatment failure rate. The secondary outcome measures were radiographic outcome, patient-rated wrist evaluation (PRWE) score, pain score and adverse events. Risk of bias was evaluated using the Cochrane Risk of Bias tool version 2. We used the Grading of Recommendations Assessment, Development and Evaluation approach to evaluate the quality of evidence. RESULTS The initial search revealed 1,775 records, and ten studies with 909 participants in total were included. There was no significant difference in DASH score in the short-term follow-up (4.99 lower, 95% confidence interval (CI): 10.45 lower to 0.46 higher; very low certainty) and treatment failure (risk ratio: 0.91, 95% CI: 0.59 to 1.40; low certainty). A clinically irrelevant but significant mean difference (0.83 lower, 95%CI: 1.64 lower to 0.03 lower; low certainty) was found in the DASH score in favour of below-elbow immobilization in the long-term follow-up. The overall risk of bias in DASH scores was high based on the measurement bias. Furthermore, there was no significant difference in secondary outcome measures. CONCLUSION This meta-analysis did not demonstrate clinically meaningful difference between below- and above-elbow immobilization in terms of DASH score both in the short- and long-term follow-ups. However, overall certainty of evidence was considered very low, based on the very serious risk of bias, inconsistency and imprecision. Hence, there is a need for further higher quality research. TRIAL REGISTRATION NUMBER UMIN000040134 (4/14/2020).
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Affiliation(s)
- Natsumi Saka
- Department of Orthopaedics, Teikyo University School of Medicine, 1-2-11 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan; Department of Health Research Methods, Evidence & Impact, McMaster University. 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada; Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan.
| | - Shota Hoshika
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan; Funabashi Orthopaedic Hospital, 1 Chome-833 Hasamacho, Funabashi, Chiba, 274-0822, Japan
| | - Madoka Inoue
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan
| | - Jun Watanabe
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan; Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke-City, Tochigi, Japan; Division of Community and Family Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
| | - Masahiro Banno
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan; Department of Psychiatry, Seichiryo Hospital, Tsurumai 4-16-27, Showa-ku, Nagoya, 466-0064, Japan; Department of Psychiatry, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Showa-ku, Nagoya, 466-8560, Japan
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Van Oijen GW, Van Lieshout EMM, Reijnders MRL, Appalsamy A, Hagenaars T, Verhofstad MHJ. Treatment options in extra-articular distal radius fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2022; 48:4333-4348. [PMID: 34009418 PMCID: PMC9712287 DOI: 10.1007/s00068-021-01679-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/19/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE This systematic literature review aimed to make a detailed overview on the clinical and functional outcomes and to get insight into the possible superiority of a treatment method for extra-articular distal radius fractures. METHODS Embase, Medline, Cochrane Library, Web of Science, and Google Scholar were searched for studies describing treatment results. Five treatment modalities were compared: plaster cast immobilization, K-wire fixation, volar plating, external fixation, and intramedullary fixation. RESULTS Out of 7,054 screened studies, 109 were included in the analysis. Overall complication rate ranged from 9% after plaster cast treatment to 18.5% after K-wire fixation. For radiographic outcomes, only volar tilt in the plaster cast group was lower than in the other groups. Apart from better grip strength after volar plating, no clear functional differences were found across treatment groups. CONCLUSION Current literature does not provide uniform evidence to prove superiority of a particular treatment method when looking at complications, re-interventions, and long-term functional outcomes.
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Affiliation(s)
- Guido W. Van Oijen
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Esther M. M. Van Lieshout
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Maarten R. L. Reijnders
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Anand Appalsamy
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Tjebbe Hagenaars
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Michael H. J. Verhofstad
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Boake BR, Childs TK, Soules TD, Zervos DL, Vincent JI, MacDermid JC. Rasch analysis of The Shoulder Pain and Disability Index (SPADI) in a postrepair rotator cuff sample. J Hand Ther 2021; 34:612-618. [PMID: 33250397 DOI: 10.1016/j.jht.2020.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/20/2020] [Accepted: 09/07/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Clinical measurement study: Level of evidence (N/A) INTRODUCTION: The Shoulder Pain and Disability Index (SPADI) is a self-reported outcome measure of pain and disability related to shoulder pathology. In comparison to Classical Test Theory (CTT), Rasch analysis offers a more rigorous examination of the measurement properties of a scale. PURPOSE OF THE STUDY This study utilizes Rasch analysis to evaluate the psychometric properties of the SPADI to propose potential modifications and avenues for future investigation. METHODS SPADI scores (n = 212) from participants one-year post rotator cuff repair were collected from an outpatient specialty clinic. Fit to the Rasch model, unidimensionality of the subscales, and areas of bias were evaluated. RESULTS Both the pain and disability subscales satisfied the requirements of the Rasch model with very minimal modifications and demonstrated unidimensionality. The person separation index was found to be high (P > .80), indicating reliability and internal consistency. Sex and the affected dominant side influenced how people scored on the SPADI (Differential item functioning (DIF)). CONCLUSIONS The findings suggest some patients in our sample have difficulty discriminating between item responses, particularly within the middle of the scale. Rasch analysis supports the clinical measurement properties of consistency and reliability, previously determined by CTT methods.
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Affiliation(s)
- Bradley R Boake
- Physiotherapist, APEX Performance Training and Rehabilitation, Hamilton, ON, Canada
| | - Timothy K Childs
- Physiotherapist, Palermo Physiotherapy and Wellness Centre, Oakville, ON, Canada
| | | | | | - Joshua I Vincent
- Post-Doctoral Fellow, School of Physical Therapy, Western University, London, ON, Canada; Roth, McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada.
| | - Joy C MacDermid
- Professor, School of Physical Therapy, Western University, London, ON, Canada; Co-Director of Clinical Research, Roth, McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
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Alnahdi AH. Structural validity of the Arabic version of the disabilities of the Arm, Shoulder and Hand (DASH) using Rasch measurement model. J Patient Rep Outcomes 2021; 5:119. [PMID: 34743235 PMCID: PMC8572284 DOI: 10.1186/s41687-021-00392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022] Open
Abstract
Background The disabilities of the arm, shoulder and hand (DASH) is a commonly used region-specific patient-reported outcome measure (PROM) that quantify upper extremity function (activity limitation) and symptoms. Current evidence suggests that measurement properties of the adapted versions of the DASH are not sufficiently examined. The Arabic DASH has evidence supporting its internal consistency, test–retest reliability, construct validity and responsiveness. On the other hand, the validity of the assumed unidimensionality of the Arabic DASH has not been examined previously. The aim of this study was to examine the structural validity of the Arabic DASH in patients with upper extremity musculoskeletal disorders using Rasch measurement model. Methods Patients with upper extremity musculoskeletal disorders were recruited and were asked to complete the Arabic DASH at their initial visit to physical therapy departments. The overall fit of the Arabic DASH to the requirement of the Rasch measurement model was examined using chi-square statistics for item-trait interaction, mean item and person fit residuals. The fit of individual items, thresholds ordering, local dependency, differential item functioning (DIF), and unidimensionality using the t-test approach were also examined. Results The Arabic DASH did not fit the Rasch measurement model initially (χ2 = 179.04, p < 0.001) with major breach of local item independence and a pattern of high residual correlations among the activity-related items and among the impairment-related items. Combining items into activity-limitation and impairment testlets accommodated the local dependency and led to satisfactory fit of the Arabic DASH to the requirement of the Rasch measurement model (χ2 = 3.99, p = 0.41). Conclusions Rasch measurement model supports the structural validity of the Arabic DASH as a unidimensional measure after the accommodation of local dependency.
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Affiliation(s)
- Ali H Alnahdi
- Rehabilitation Sciences Department, College of Applied Medical, Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia.
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Wouters RM, Jobi-Odeneye AO, de la Torre A, Joseph A, Hovius SER. A Standard Set for Outcome Measurement in Patients With Hand and Wrist Conditions: Consensus by the International Consortium for Health Outcomes Measurement Hand and Wrist Working Group. J Hand Surg Am 2021; 46:841-855.e7. [PMID: 34325941 DOI: 10.1016/j.jhsa.2021.06.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the principles, process, and results of creating the International Consortium for Health Outcomes Measurement (ICHOM) standard set for hand and wrist conditions. METHODS Following the standardized methods of ICHOM, an international working group of hand surgeons, therapists, and researchers was assembled to develop an evidence-based, patient-centered, standard set of outcome measures for patients with hand and wrist conditions. Multiple systematic reviews were performed to support our choices of outcome domains and tools for hand and wrist conditions. Fourteen video conferences were held between March 2018 and March 2020, and a modified Delphi process was used. RESULTS A consensus was reached on 5 measurement tracks: the thumb, finger, wrist, nerve, and severe hand trauma tracks, with a distinction between regular and extended tracks for which specific allocation criteria applied. The standard set contains a selection of outcome tools and predefined time points for outcome measurement. Additionally, we developed a hierarchy for using the tracks when there are multiple conditions, and we selected risk-adjustment, case-mix variables. CONCLUSIONS The global implementation of the ICHOM standard set for hand and wrist conditions may facilitate value-based health care for patients with hand and wrist conditions. CLINICAL RELEVANCE The ICHOM standard set for hand and wrist conditions can enable clinical decision making, quality improvement, and comparisons between treatments and health care professionals.
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Affiliation(s)
- Robbert M Wouters
- Department of Plastic, Reconstructive and Hand Surgery, Department of Rehabilitation Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Center for Hand Therapy, Handtherapie Nederland Hand and Wrist Center, Xpert Clinics, the Netherlands.
| | | | - Alethse de la Torre
- the International Consortium for Health Outcomes Measurement, London, United Kingdom
| | - Andria Joseph
- the International Consortium for Health Outcomes Measurement, London, United Kingdom
| | | | - Steven E R Hovius
- Hand and Wrist Center, Xpert Clinic, Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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Pearson NA, Tutton E, Joeris A, Gwilym S, Grant R, Keene DJ, Haywood KL. Co-producing a multi-stakeholder Core Outcome Set for distal Tibia and Ankle fractures (COSTA): a study protocol. Trials 2021; 22:443. [PMID: 34247628 PMCID: PMC8273034 DOI: 10.1186/s13063-021-05415-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/01/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Ankle fracture is a common injury with a strong evidence base focused on effectiveness of treatments. However, there are no reporting guidelines on distal tibia and ankle fractures. This has led to heterogeneity in outcome reporting and consequently, restricted the contribution of evidence syntheses. Over the past decade, core outcome sets have been developed to address this issue and are available for several common fractures, including those of the hip, distal radius, and open tibial fractures. This protocol describes the process to co-produce-with patient partners and other key stakeholders-a multi-stakeholder derived Core Outcome Set for distal Tibia and Ankle fractures (COSTA). The scope of COSTA will be for clinical trials. METHODS The study will have five-stages which will include the following: (i) systematic reviews of existing qualitative studies and outcome reporting in randomised controlled trial studies to inform a developing list of potential outcome domains; (ii) qualitative interviews (including secondary data) and focus groups with patients and healthcare professionals to explore the impact of ankle fracture and the outcomes that really matter; (iii) generation of meaningful outcome statements with the study team, international advisory group and patient partners; (iv) a multi-round, international e-Delphi study to achieve consensus on the core domain set; and (v) an evidence-based consensus on a core measurement set will be achieved through a structured group consensus meeting, recommending best assessment approaches for each of the domains in the core domain set. DISCUSSION Development of COSTA will provide internationally endorsed outcome assessment guidance for clinical trials for distal tibia and ankle fractures. This will enhance comparative reviews of interventions, potentially reducing reporting bias and research waste.
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Affiliation(s)
- Nathan A. Pearson
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Elizabeth Tutton
- Oxford Trauma and Emergency Care, Kadoorie Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Trauma and Major Trauma Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | | | - Stephen Gwilym
- Oxford Trauma and Emergency Care, Kadoorie Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Richard Grant
- National Institute for Health Research, Applied Research Collaboration, Coventry, UK
- Warwick Medical School, User Teaching and Research Action Partnership, Coventry, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal sciences, Fragility Fracture Network, University of Oxford, Oxford, UK
| | - David J. Keene
- Oxford Trauma and Emergency Care, Kadoorie Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Kirstie L. Haywood
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
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Okamura A, de Moraes VY, Neto JR, Tamaoki MJ, Faloppa F, Belloti JC. No benefit for elbow blocking on conservative treatment of distal radius fractures: A 6-month randomized controlled trial. PLoS One 2021; 16:e0252667. [PMID: 34111160 PMCID: PMC8191961 DOI: 10.1371/journal.pone.0252667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/18/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose For displaced distal radius fracture, this trial aimed to compare an above-elbow (AE) and below-elbow (BE) cast at the end of a 24-week follow-up using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire as a primary outcome. Methods This is a clinical trial with parallel groups (1:1) and a blinded evaluator. There are two non-surgical interventions: AE and BE. A total of 128 adult patients with acute (up to 7 days) displaced distal radius fracture of type A2-3, C1-3 by the AO classification were included. The follow-up was 24 weeks. The primary outcome was the DASH questionnaire at 24 weeks. Secondary outcomes were the maintenance of reduction by the evaluation of radiographic parameters, pain measured by VAS, PRWE, objective functional evaluation and rate of adverse effects. Results The difference between the two groups in the DASH score at 24 weeks was not significant, with the mean (95% CI) DASH score being AE: 9.44 (2.70 to 16.17) vs. BE: 9.88 (3.19 to 16.57) (p = 0.895). The above-elbow group had a significantly greater worsening of the mean DASH score from baseline to 2 weeks (p < 0.001). No statistically significant differences were found between the 2 groups in any of the other follow-up assessments. Objective functional evaluation, PRWE, radiographical measures and rates of reduction loss were similar between groups. Above-elbow casting resulted in more adverse effects (mostly shoulder pain; 19 events vs. 9 events); RR = 0.39 (0.19–0.94); p = 0.033 at the end of six-month follow-up. Conclusions This study did not demonstrate a difference between above-elbow and below-elbow cast in terms of DASH outcome at 6 months in non-surgical treatment of deviated distal radius fractures. However, below-elbow casting is less debilitating during the treatment period, has comparable performance in maintaining the reduction, and is related to fewer minor adverse effects than above-elbow casting.
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Affiliation(s)
- Aldo Okamura
- Department of Orthopaedics and Traumatology, Unit of Hand Surgery, Universidade Federal de São Paulo (Unifesp -EPM), São Paulo, Brazil
- Division of Orthopaedics and Traumatology, Hospital Municipal Dr. Fernando Mauro Pires da Rocha (Hospital do Campo Limpo), São Paulo, Brazil
- Hand Surgery Division, Hospital Alvorada Moema–United Health Group, São Paulo, Brazil
- * E-mail:
| | - Vinícius Ynoe de Moraes
- Department of Orthopaedics and Traumatology, Unit of Hand Surgery, Universidade Federal de São Paulo (Unifesp -EPM), São Paulo, Brazil
- Hand Surgery Division, Hospital Alvorada Moema–United Health Group, São Paulo, Brazil
| | - Jorge Raduan Neto
- Department of Orthopaedics and Traumatology, Unit of Hand Surgery, Universidade Federal de São Paulo (Unifesp -EPM), São Paulo, Brazil
- Hand Surgery Division, Hospital Alvorada Moema–United Health Group, São Paulo, Brazil
| | - Marcel Jun Tamaoki
- Department of Orthopaedics and Traumatology, Unit of Hand Surgery, Universidade Federal de São Paulo (Unifesp -EPM), São Paulo, Brazil
| | - Flavio Faloppa
- Department of Orthopaedics and Traumatology, Unit of Hand Surgery, Universidade Federal de São Paulo (Unifesp -EPM), São Paulo, Brazil
| | - João Carlos Belloti
- Department of Orthopaedics and Traumatology, Unit of Hand Surgery, Universidade Federal de São Paulo (Unifesp -EPM), São Paulo, Brazil
- Hand Surgery Division, Hospital Alvorada Moema–United Health Group, São Paulo, Brazil
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Abstract
Distal radius fractures (DRFs) are among the most common upper extremity injuries. Multiple medical conditions now are evaluated by standardized outcome sets that enable comparability. Recent international working groups have provided consensus statements for outcomes measurement after DRFs. These statements emphasized the growing importance of patient-reported outcome measures as well as traditional measures, including pain assessment, radiographic alignment, performance, and assessment of complications. A standardized instrument and timeline for measuring outcomes following DRFs offers clinicians, researchers, and health care economists a powerful tool. This article reviews the current evidence and provides recommendations for a DRF standardized outcome set.
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Affiliation(s)
- Matthew J Hall
- Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Boston, MA 02114, USA
| | - Peter J Ostergaard
- Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Boston, MA 02114, USA
| | - Tamara D Rozental
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA 02115, USA.
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Thorninger R, Wæver D, Pedersen J, Tvedegaard-Christensen J, Tjørnild M, Lind M, Rölfing JD. Objective Outcome Measures Continue to Improve from 6 to 12 Months after Conservatively Treated Distal Radius Fractures in the Elderly-A Prospective Evaluation of 50 Patients. J Clin Med 2021; 10:1831. [PMID: 33922371 DOI: 10.3390/jcm10091831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 12/20/2022] Open
Abstract
Distal radius fractures (DRF) in the elderly population above 65 years represent 18% of all fractures and are thereby the second most frequent fracture in the elderly. Fracture dislocation and comminution are often used to determine whether non-operative or operative treatment is indicated. The purpose of this prospective case series of minimally displaced DRF treated with a dorsal cast was to assess the complication rate and patient-reported outcome measures. This single-centre, single-blinded, prospective case series followed 50 conservatively treated DRF patients for one year. Primary outcomes were complications and Quick Disability of Arm Shoulder and Hand (qDASH) score. Secondary outcomes were range of motion (ROM), grip strength and pain, and Patient-Rated Wrist/Hand Evaluation (PRWHE). Results showed only minor complications with a return to prior ROM, qDASH, and pain after 12 months and improvement in outcomes after 6-12 months. In conclusion, the majority of DRF patients who were treated non-operatively with five-week dorsal casting recover fully after minimally displaced DRF. This standard approach is thus considered safe, and the present results provide a reference for other studies.
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Ciani O, Salcher-Konrad M, Meregaglia M, Smith K, Gorst SL, Dodd S, Williamson PR, Fattore G. Patient-reported outcome measures in core outcome sets targeted overlapping domains but through different instruments. J Clin Epidemiol 2021; 136:26-36. [PMID: 33689837 DOI: 10.1016/j.jclinepi.2021.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/13/2021] [Accepted: 03/02/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE There is no comprehensive assessment of which patient-reported outcomes (PROs) are recommended in core outcome sets (COS), and how they should be measured. The aims of this study are to review COS that include patient-reported outcomes measures (PROMs), identify their target health domains, main characteristics, and their overlap within and across different disease areas. STUDY DESIGN AND SETTING We selected COS studies collected in a publicly available database that included at least one recommended PROM. We gathered information on study setting, disease area, and targeted outcome domains. Full-text of recommended instruments were obtained, and an analysis of their characteristics and content performed. We classified targeted domains according to a predefined 38-item taxonomy. RESULTS Overall, we identified 94 COS studies that recommended 323 unique instruments, of which: 87% were included in only one COS; 77% were disease-specific; 1.5% preference-based; and 61% corresponded to a full questionnaire. Most of the instruments covered broad health-related constructs, such as global quality of life (25%), physical functioning (22%), emotional functioning and wellbeing (7%). CONCLUSION The wealth of recommended instruments observed even within disease areas does not fit with a vision of systematic, harmonized collection of PROM data in COS within and across disease areas.
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Affiliation(s)
- Oriana Ciani
- Centre for Research on Health and Social Care Management, SDA Bocconi, via Sarfatti 10, 20136, Milan, Italy; Evidence Synthesis and Modeling for Health Improvement, College of Medicine and Health, University of Exeter, EX1 2LU, Exeter, UK.
| | - Maximilian Salcher-Konrad
- LSE Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK; Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Michela Meregaglia
- Centre for Research on Health and Social Care Management, SDA Bocconi, via Sarfatti 10, 20136, Milan, Italy
| | | | - Sarah L Gorst
- MRC/NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool L69 3BX, UK
| | - Susanna Dodd
- MRC/NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool L69 3BX, UK
| | - Paula R Williamson
- MRC/NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool L69 3BX, UK
| | - Giovanni Fattore
- Centre for Research on Health and Social Care Management, SDA Bocconi, via Sarfatti 10, 20136, Milan, Italy; Department of Social and Political Science, Bocconi University, via Sarfatti 36, 20136, Milan, Italy
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Deshmukh SR, Mousoulis C, Marson BA, Grindlay D, Karantana A. Developing a core outcome set for hand fractures and joint injuries in adults: a systematic review. J Hand Surg Eur Vol 2021; 46:1753193420983719. [PMID: 33487059 DOI: 10.1177/1753193420983719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study identifies the treatment outcome domains used in recently published studies on the treatment of hand fractures and joint injuries with the aim to inform development of a core outcome set. Seven databases were searched from January 2014 to March 2019 for randomized and quasi-randomized studies and large prospective observational studies. We identified 1777 verbatim outcomes in 160 eligible studies. From the verbatim outcomes we distinguished 639 unique outcomes, which we categorized into 74 outcome domains based on the World Health Organization International Classification of Functioning, Disability, and Health framework. The primary outcome was appropriately identified in only 65% (72/110) of randomized and quasi-randomized controlled trials. Of the 72 studies with a primary outcome identified, 74% (53/72) had an appropriate power calculation. The vast heterogeneity in outcome selection across studies highlights the need for a core outcome set of what outcomes to measure in future clinical research on hand fractures and joint injuries.
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Affiliation(s)
- Sandeep Rajiv Deshmukh
- Centre for Evidence Based Hand Surgery, Academic Orthopaedics, Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK
| | - Christos Mousoulis
- Centre for Evidence Based Hand Surgery, Academic Orthopaedics, Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK
| | - Ben A Marson
- Trauma Outcomes Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK *Authors' details are listed in the acknowledgements section
| | - Douglas Grindlay
- Centre for Evidence Based Hand Surgery, Academic Orthopaedics, Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK
| | - Alexia Karantana
- Centre for Evidence Based Hand Surgery, Academic Orthopaedics, Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK
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Jumbo SU, MacDermid JC, Packham TL, Athwal GS, Faber KJ. Reproducibility: reliability and agreement parameters of the Revised Short McGill Pain Questionnaire Version-2 for use in patients with musculoskeletal shoulder pain. Health Qual Life Outcomes 2020; 18:365. [PMID: 33176784 DOI: 10.1186/s12955-020-01617-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/03/2020] [Indexed: 12/03/2022] Open
Abstract
Background The Revised Short McGill Pain Questionnaire Version-2 (SF-MPQ-2) is a multidimensional outcome measure designed to capture, evaluate and discriminate pain from neuropathic and non-neuropathic sources. A recent systematic review found insufficient psychometric data with respect to musculoskeletal (MSK) health conditions. This study aimed to describe the reproducibility (test–retest reliability and agreement) and internal consistency of the SF-MPQ-2 for use among patients with musculoskeletal shoulder pain. Methods Eligible patients with shoulder pain from MSK sources completed the SF-MPQ-2: at baseline (n = 195), and a subset did so again after 3–7 days (n = 48), if their response to the Global Rating of Change (GROC) scale remained unchanged. Cronbach alpha (α) and intraclass correlation coefficient (ICC2,1), and their related 95% CI were calculated. Standard error of measurement (SEM), group and individual minimal detectable change (MDC90), and Bland–Altman (BA) plots were used to assess agreement. Results Cronbach α ranged from 0.83 to 0.95 suggesting very satisfactory internal consistency across the SF-MPQ-2 domains. Excellent ICC2,1 scores were found in support of the total scale (0.95) and continuous subscale (0.92) scores; the remaining subscales displayed good ICC2,1 scores (0.78–0.88). Bland–Altman analysis revealed no systematic bias between the test and retest scores (mean difference = 0.13–0.19). While the best agreement coefficients were seen on the total scale (SEM = 0.5; MDC90individual = 1.2 and MDC90group = 0.3), they were acceptable for the SF-MPQ-2 subscales (SEM: range 0.7–1; MDC90individual: range 1.7–2.3; MDC90group: range 0.4–0.5). Conclusion Good reproducibility supports the SF-MPQ-2 domains for augmented or independent use in MSK-related shoulder pain assessment, with the total scale displaying the best reproducibility coefficients. Additional research on the validity and responsiveness of the SF-MPQ-2 is still required in this population.
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Chevance A, Tran V, Ravaud P. Controversy and Debate Series on Core Outcome Sets. Paper 1: Improving the generalizability and credibility of core outcome sets (COS) by a large and international participation of diverse stakeholders. J Clin Epidemiol 2020; 125:206-212.e1. [DOI: 10.1016/j.jclinepi.2020.01.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 10/03/2019] [Accepted: 01/01/2020] [Indexed: 11/21/2022]
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Cheema AS, O’Brien PJ, Broekhuyse HM, Lefaivre KA. Measuring Outcomes Over Time in Distal Radius Fractures: A Comparison of Generic, Upper Extremity-Specific and Wrist-Specific Outcome Measures. J Hand Surg Glob Online 2020; 2:272-276. [PMID: 35415515 PMCID: PMC8991422 DOI: 10.1016/j.jhsg.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/25/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose This study compared the responsiveness of a generic (Short Form-36 [SF-36]), an upper extremity-specific (Disabilities of the Arm, Shoulder, and Hand [DASH]) and a wrist-specific (Patient-Rated Wrist Evaluation [PRWE]) outcome score when evaluating distal radius fractures over time. Methods We observed 235 patients who met the inclusion criteria of an isolated distal radius fracture treated surgically or nonsurgically and greater than age 50 years for 12 months in this prospective study. Standardized assessments were performed at baseline and at 6 and 12 months. Exclusion criteria included subjects with concomitant injuries in the ipsilateral limb and follow-up of less than 1 year. Responsiveness was evaluated through the standardized response mean and the proportion who met a minimal clinically important difference. Floor and ceiling effects were also calculated. Results The standardized response mean was significantly greatest for the DASH between baseline and 6 months (P < .001), and the PRWE between both baseline and 6 months (P < .01) and 6 and 12 months (P < .01) compared with the SF-36. The proportion of patients who met a minimal clinically important difference between baseline and 6 months was greater in the PRWE, but it did not meet statistical significance (P = .12). The PRWE demonstrated a high ceiling effect at baseline (76.6%) but less so at 12 months (16.9%). The DASH demonstrated similar ceiling effects at baseline (62.9%) and 12 months (18.6%). The SF-36 had no ceiling effect. Conclusions In the first 6 months, both the DASH and PRWE have greater responsiveness in assessing change over the SF-36 in distal radius fractures. From 6 to 12 months, the wrist-specific PRWE has greater responsiveness over both the DASH and SF-36. This supports the use of the anatomy- and injury-specific outcome measures over the generic outcome measure in detecting change over a patient's early recovery. However, as the time from injury increases, the absence of a ceiling effect from the generic outcome measure may become more useful. Clinical relevance This study demonstrates the responsiveness of the DASH, PRWE, and SF36 in assessing distal radius fractures treated in patients greater than age 50 in the first year. In establishing the most responsive measure, respondent burden can be decreased in future research.
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Affiliation(s)
- Amarpal S. Cheema
- Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter J. O’Brien
- Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of British Columbia, Vancouver, British Columbia, Canada
| | - Henry M. Broekhuyse
- Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly A. Lefaivre
- Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of British Columbia, Vancouver, British Columbia, Canada
- Corresponding author: Kelly A. Lefaivre, MD, MSc, FRCSC, Department of Orthopaedics, Division of Orthopaedic Trauma, University of British Columbia, VGH Research Pavilion, 110-828 West 10th Avenue, Vancouver, BC, Canada V5Z 1M9.
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Gorst SL, Prinsen CA, Salcher-konrad M, Matvienko-sikar K, Williamson PR, Terwee CB. Methods used in the selection of instruments for outcomes included in core outcome sets have improved since the publication of the COSMIN/COMET guideline. J Clin Epidemiol 2020; 125:64-75. [DOI: 10.1016/j.jclinepi.2020.05.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/21/2020] [Accepted: 05/20/2020] [Indexed: 12/17/2022]
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Selles RW, Wouters RM, Poelstra R, van der Oest MJW, Porsius JT, Hovius SER, Moojen TM, van Kooij Y, Pennehouat PY, van Huis R, Vermeulen GM, Feitz R, Slijper HP. Routine Health Outcome Measurement: Development, Design, and Implementation of the Hand and Wrist Cohort. Plast Reconstr Surg 2020; 146:343-354. [PMID: 32740587 DOI: 10.1097/prs.0000000000007008] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Routine measurement of outcome of clinical care is increasingly considered important, but implementation in practice is challenging. This article describes (1) how the authors created and implemented a routine outcome measurement cohort of patients with hand and wrist conditions and (2) how these data are used to improve the quality of care and facilitate scientific research. Starting in 2011, routine outcome measurement was implemented at all practice sites (currently 22) of a specialized treatment center for hand and wrist conditions across The Netherlands. The authors developed five "measurement tracks," including measurements administered at predetermined time points covering all hand and wrist disorders and treatments. An online system automatically distributes measurements among patients, which can be accessed by health care professionals. Using this system, the total number of yearly assigned tracks increased up to over 16,500 in 2018, adding up to 85,000 tracks in 52,000 patients in total. All surgeons, therapists, and other staff have direct access to individual patient data and patients have access to their treatment information using a secure patient portal. The data serve as a basis for studies on, among others, comparative effectiveness, prediction modeling, and clinimetric analyses. In conclusion, the authors present the design and successful implementation of a routine outcome measurement system that was made feasible using a highly automated data collection infrastructure, tightly linked to the patient journey and the workflow of health care professionals. The system serves not only as a tool to improve care but also as a basis for scientific research studies.
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Affiliation(s)
- Ruud W Selles
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Robbert M Wouters
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Ralph Poelstra
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Mark J W van der Oest
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Jarry T Porsius
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Steven E R Hovius
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Thybout M Moojen
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Yara van Kooij
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Pierre-Yves Pennehouat
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Rob van Huis
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Guus M Vermeulen
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Reinier Feitz
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Harm P Slijper
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
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Abstract
The use of patient-reported outcome measures (PROs) in research and clinical use in orthopedic trauma surgery has increased dramatically over the past decades, and this trend will continue in the future. This review aimed to provide insight into the way PROs can best be identified, reviewed, selected, and used in orthopedic trauma studies and patient care. Selection of instruments for a specific (research) question starts with a systematic literature review for identifying the mostly used instruments. From this list, the instruments that are most suitable for the intended use are selected. Readability, usability, and costs should be considered at this stage. For the selected instruments, the next step is to search the literature systematically in order to determine if the measurement properties of these instruments meet the quality standard as outlined by the COSMIN group. Instruments need to be valid for the targeted condition, intervention as well as population. If not available in the primary language of the targeted population, the instrument requires translation according to a state of the art procedure and validation in the new language. Reporting guidelines like the SPIRIT-PRO and CONSORT-PRO are available in order to guide the reporting of PROs in study protocol and outcome reports, respectively. Using Core Outcome Sets improves the validity of results of clinical research and increases the feasibility of conducting meta-analyses. If the standards and procedures as outlined above are used, the use of PROs will contribute to improved patient care and clinical research.
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Affiliation(s)
- Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, P.O. Box 2040, The Netherlands.
| | - Mathieu M E Wijffels
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, P.O. Box 2040, The Netherlands
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Tomruk M, Gelecek N, Basçi O, Özkan M. Effects of early manual therapy on functional outcomes after volar plating of distal radius fractures: A randomized controlled trial. Hand Surgery and Rehabilitation 2020; 39:178-185. [DOI: 10.1016/j.hansur.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/11/2019] [Indexed: 12/19/2022]
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Lameijer CM, Ten Duis HJ, Haag CMSC, El Moumni M, van der Sluis CK. The evolution of radiological measurements and the association with clinician and patient reported outcome following distal radius fractures in non-osteoporotic patients: what is clinically relevant? Disabil Rehabil 2020; 43:3777-3788. [PMID: 32356451 DOI: 10.1080/09638288.2020.1753247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction: Following distal radius fractures in young non-osteoporotic patients, clinical relevancy of outcome has been scarcely reported. Outcome can be put in perspective by using measurement errors of radiological measurements and Minimal Important Change when reporting on clinician and patient reported outcome. Aim of this study was to assess the clinical relevance of radiological measurements, clinician and patient reported outcomes following distal radius fractures in young non-osteoporotic patients.Methods: Retrospective cohort study. Non-osteoporotic patients following a distal radius fracture were selected. Radiographs of both wrists were obtained at baseline, 6 weeks and at follow-up. Active range of motion and grip strength measurements were obtained at the follow-up visit and 4 questionnaires were answered to assess pain, upper extremity functioning, and health status.Results: Seventy-three patients (32 women, 41 men) with a mean age of 33.5 (SD 9.2) years at the time of injury were included. Median follow up was 62 months (IQR 53.0-84.5). Several radiological measurements evolved statistically significantly over time, however none exceeded measurement errors. Flexion/extension difference of injured compared to uninjured wrist (mean difference 11.2°, t = -7.5, df = 72, p < 0.001), exceeded Minimal Important Change, while grip strength differences did not. When comparing patients with DRFs to healthy controls, only the differences on Patient Reported Wrist Evaluation subscales "pain", "function" and total scores exceeded minimal important change (8, 10 and 13 points, respectively). Multivariable regression analysis revealed statistically significant relationships between residual step-off and respectively diminished flexion/extension (B = -36.8, 95% CI -62; -11.1, p = 0.006), diminished radial/ulnar deviation (B = -17.9, 95% CI -32.0; -3.9, p = 0.013) and worse ShortForm-36 "mental component score" (B = -15.4, 95% CI -26.6; -4.2, p < 0.001).Conclusion: Radiological measurements following distal radius fractures seem to evolve over time, but differences were small and were probably not clinically relevant. Range of motion, in particular flexion/extension, was impaired to such extend that it was noticeable for a patient, whereas grip strength was not impaired. The Patient Reported Wrist Evaluation was clinically relevantly diminished. Residual articular incongruency seems to influence range of motion.Implications for rehabilitationReporting Minimal Important Change regarding clinician and patient reported outcome following distal radius fractures is of more clinical value than reporting on statistical significance.Following distal radius fractures, the changes in radiological measurements do not seem to reflect a clinical relevant change.Range of motion, in particular flexion/extension, should be measured following distal radius fractures, as this might be impaired in a clinically relevant way.Measuring grip strength is of less importance following distal radius fractures, because grip strength does not seem to be affected.Residual articular incongruency seems to influence range of motion and therefore should be reduced to a minimum when treating non-osteoporotic patients.
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Affiliation(s)
- Charlotte M Lameijer
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henk Jan Ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Charlotte M S C Haag
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mostafa El Moumni
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Corry K van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Quadlbauer S, Pezzei C, Jurkowitsch J, Rosenauer R, Kolmayr B, Keuchel T, Simon D, Beer T, Hausner T, Leixnering M. Rehabilitation after distal radius fractures: is there a need for immobilization and physiotherapy? Arch Orthop Trauma Surg 2020; 140:651-663. [PMID: 32193679 DOI: 10.1007/s00402-020-03367-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 02/07/2023]
Abstract
Although the literature generally agrees that displaced distal radius fractures require surgery, no single consensus exists concerning the length of immobilization and type of post-operative physiotherapeutic rehabilitation program. Palmar locking plate fixation represents a very stable fixation of the distal radius, and was assessed biomechanically in various studies. Surprisingly, most authors report additional immobilization after plate fixation. One reason might be due to the pain caused during active wrist mobilization in the early post-operative stages or secondly to protect the osteosynthesis in the early healing stages preventing secondary loss of reduction. This article addresses the biomechanical principles, current available evidence for early mobilization/immobilization and impact of physiotherapy after operatively treated distal radius fractures.
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Affiliation(s)
- S Quadlbauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.
- Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.
- Austrian Cluster for Tissue Regeneration, 1200, Vienna, Austria.
| | - Ch Pezzei
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - J Jurkowitsch
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - R Rosenauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
- Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, 1200, Vienna, Austria
| | - B Kolmayr
- Department of Physiotherapy, AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, 1200, Vienna, Austria
| | - T Keuchel
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - D Simon
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - T Beer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - T Hausner
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
- Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, 1200, Vienna, Austria
- Department for Orthopedic Surgery and Traumatology, Paracelsus Medical University, 5020, Salzburg, Austria
| | - M Leixnering
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
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Lloyd-Hughes H, Geoghegan L, Rodrigues J, Peters M, Beard D, Price A, Jain A. Systematic Review of the Use of Patient Reported Outcome Measures in Studies of Electively-Managed Hand Conditions. J Hand Surg Asian Pac Vol 2019; 24:329-341. [PMID: 31438799 DOI: 10.1142/s2424835519500425] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Electively-managed conditions account for over 100 000 inpatient surgeries a year in the English National Health Service alone, with further procedures in other regions of the UK, or performed on an outpatient basis. To quality assure this care and to conduct research, effective outcome measurement is critical. Traditional surgeon-centric outcome measures correlate poorly with hand function and are seldom important to patients. There has been an advent in the use of patient reported outcome measures (PROMs) in hand surgery although consensus of PROM choice appears to be lacking. This systematic review aimed to describe the use of relevant PROMs in clinical research of electively-managed hand conditions. Methods: A PRISMA-compliant methodology was used. A bespoke search strategy was developed in conjunction with a search strategist, and applied to Medline, EMBASE, CINAHL and PSYCHINFO from 1992 to June 2017. Pre-specified stepwise inclusion criteria were used to identify studies describing adult patients undergoing treatment for electively-managed hand conditions distal to the distal radius, with clinical outcomes measured using one or more PROMs. Results: Of 4554 results, 834 met inclusion criteria. PROMs identified included 9 disease-specific, 8 site-specific and 4 generic quality of life measures. Across all, the Disabilities of the Arm, Shoulder and Hand (DASH) was the most commonly used (overall frequency 41.0%). The most commonly reported disease-specific measure was the Boston Carpal Tunnel Questionnaire (overall frequency 23.0%). The most commonly reported generic quality of life of measure was the SF-36 (overall frequency 4%). Time-analysis demonstrated predominance of site-specific PROMs since the year 2000. Conclusions: Various PROMs have been used to study electively-managed hand conditions, with site-specific PROMs most popular. However, there appears to be limited consensus on choices. A future systematic evaluation of the published psychometric properties of identified PROMs may inform standardisation of measurement.
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Affiliation(s)
- Hawys Lloyd-Hughes
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Luke Geoghegan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Jeremy Rodrigues
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Michele Peters
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Abhilash Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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Nowak LL, Davis AM, Mamdani M, Beaton D, Schemitsch EH. A concept analysis and overview of outcome measures used for evaluating patients with proximal humerus fractures. Disabil Rehabil 2019; 43:1450-1462. [PMID: 31479302 DOI: 10.1080/09638288.2019.1649728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE It is unclear to which degree existing studies evaluate the primary goal of treatment for patients with proximal humerus fractures (restoration of daily activities). Our purpose was to systematically review and analyze the concepts reflected by outcome measures used in studies of patients with proximal humerus fractures. METHODS We reviewed three databases from 2000 to 2018. Two reviewers categorized outcomes in each study into concepts of the International Classification of Functioning, Disability and Health framework. RESULTS The most commonly represented concept across 35 studies was "Body Function/Structure Impairment", followed by aggregate measures that reflect multiple concepts to varying degrees. All patient-reported aggregate measures such as the Disabilities of the Arm, Shoulder, and Hand, American Shoulder and Elbow Surgeon's, and Oxford Shoulder scores better reflected "Activity Limitations", however, these measures were only reported in 34% of studies. CONCLUSION There may be misalignment between what studies measure, and the primary goal of treatment for patients with proximal humerus fractures. The Disabilities of the Arm, Shoulder and Hand, American Shoulder and Elbow Surgeon's, and Oxford Shoulder scores reflect concepts that more adequately address the restoration of daily activities following these injuries, and future studies should include at least one of these measures.Implications for rehabilitationWe have shown that there is a misalignment between what existing studies are measuring (primarily objective measures of impairment) and the primary goal of treatment and rehabilitation (restoring activities of daily living).This suggests that existing studies evaluating different treatment types for proximal humerus fracture patients are providing inadequate information to make evidence-based treatment and rehabilitation decisions following theses injuries.Our results tentatively suggest that the Disabilities of the Arm, Shoulder and Hand, the American Shoulder and Elbow Surgeon's, and Oxford Shoulder scores may better reflect limitations in daily activities following these injuries and should be used in future studies and by clinicians.
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Affiliation(s)
- Lauren L Nowak
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Clinical Orthopaedic Research, St. Michael's Hospital, Toronto, Canada
| | - Aileen M Davis
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Muhammad Mamdani
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Li Ka Shing Centre for Healthcare Analytics Research and Training, St. Michael's Hospital, Toronto, Canada
| | - Dorcas Beaton
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Musculoskeletal Health & Outcomes Research, Institute for Work Health, Toronto, Canada
| | - Emil H Schemitsch
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Clinical Orthopaedic Research, St. Michael's Hospital, Toronto, Canada.,Division of Orthopaedic Surgery, London Health Sciences Centre, London, Canada
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Nowak LL, Davis AM, Mamdani M, Beaton D, Kennedy C, Schemitsch EH. A Systematic Review and Standardized Comparison of Available Evidence for Outcome Measures Used to Evaluate Proximal Humerus Fracture Patients. J Orthop Trauma 2019; 33:e256-62. [PMID: 31135514 DOI: 10.1097/BOT.0000000000001462] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To summarize and appraise any patient-reported or clinician-measured outcome measures based on their measurement properties in proximal humerus fracture patients. DATA SOURCES AND STUDY SELECTION MEDLINE, EMBASE, and CINAHL were searched from January 2000 to August 2018 to identify all studies of proximal humerus fracture patients that reported a measurement property evaluation of an outcome measure. DATA EXTRACTION AND SYNTHESIS Quality appraisal of each measure was completed using the Evaluating the Measurement of Patient-Reported Outcomes (EMPRO) tool. The EMPRO takes into account all studies of each measure, and the overall score is transformed linearly to a range of 0 (lowest) to 100 (best). RESULTS Eleven instruments were identified. Intended concepts of the instruments included clinician-measured shoulder function, patient-reported function or disability, and patient-reported general health state. Only the Disabilities of the Arm, Shoulder and Hand (DASH), Oxford Shoulder Score, Constant Score, University of California, Los Angeles Shoulder Score, and EuroQol 5 Dimension (EQ5D) were evaluated in more than 1 study. The Shoulder Function Index (SFINX), DASH, and EQ5D had the highest EMPRO scores (80, 66, and 58, respectively). The SFINX and DASH consistently scored among the top 3 instruments for each attribute. CONCLUSIONS Evidence on the measurement properties of outcome measures for proximal humerus fracture patients is limited. With the available evidence, the SFINX is recommended as a clinician-measured functional outcome measure, the DASH as a patient-reported functional outcome measure, and the EQ5D as a general health status measure.
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Heidgerd R, Morgan J, Schentrup D. Evaluation of Functional Outcomes for Adult Patients After Distal Radius Fracture Treated With Volar Plate Fixation Versus Nonsurgical Care. J Trauma Nurs 2019; 26:59-64. [PMID: 30624384 DOI: 10.1097/JTN.0000000000000416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Distal radius fractures are one of the most common fractures patients experience. Although there are a variety of treatments, there is a lack of standardization as it relates to treatment of such fractures. The purpose of this study was to compare treatment outcomes between surgical and nonsurgical care of distal radius fractures to inform evidence-based guidelines for the management of distal radius fractures. A retrospective chart analysis was performed in the public university hospital setting on a sample of 60 patient health records divided equally into those treated surgically and nonsurgically. Data were analyzed related to specific variables in those patients who met specific inclusion/exclusion criteria. Analysis identified that patients treated surgically experienced improved healing and return of range of motion. There was no statistical significance comparing pain in both the surgical and nonsurgical groups. Diabetes and smoking were found to have a negative impact on healing and clinical outcomes. Despite limitations, this pilot project serves as a baseline for future research regarding best practices in the treatment of distal radius fractures. It also demonstrates the negative impact that diabetes and smoking can have on clinical outcomes.
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Watson N, Haines T, Tran P, Keating JL. A Comparison of the Effect of One, Three, or Six Weeks of Immobilization on Function and Pain After Open Reduction and Internal Fixation of Distal Radial Fractures in Adults: A Randomized Controlled Trial. J Bone Joint Surg Am 2018; 100:1118-1125. [PMID: 29975268 DOI: 10.2106/jbjs.17.00912] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimum period of immobilization following open reduction and internal fixation (ORIF) of distal radial fractures has not been established. METHODS One hundred and thirty-three adults with a distal radial fracture treated with ORIF (using a volar locked plate) were randomly allocated, with stratification according to age, to 1, 3, or 6 weeks of postoperative immobilization in a parallel-design, assessor-blinded, randomized controlled trial (RCT). After cast removal, a standardized education and exercise program was followed for 6 weeks. Primary outcomes were function (according to the Patient-Rated Wrist Evaluation [PRWE]), worst (visual analog scale [VAS]-W) and usual (VAS-U) pain in the past week, and active wrist extension and forearm supination range of motion. All measures were recorded at 6, 12, and 26 weeks following surgery. Secondary outcomes were wrist flexion, radial deviation, ulnar deviation, and forearm pronation active range of motion; function (Disabilities of the Arm, Shoulder and Hand [DASH]); grip strength; postoperative adverse events; return to work and/or usual daily activities; and compliance with the home exercise program. RESULTS More than 90% of the participants received treatment as allocated, and 87% completed the 6-month follow-up. At 6 weeks, both the 1-week and 3-week groups had significantly better PRWE scores, wrist extension, and flexion active range of motion than the 6-week group. However, no treatment group was superior to another with respect to primary or secondary outcomes at 12 weeks or 6 months following surgery. Analyses considering only the main effect of the intervention group indicated a preference for the 3-week group, which performed significantly better than the 6-week group with respect to the PRWE, pain (VAS-W and VAS-U), wrist flexion, ulnar deviation, forearm pronation active range of motion, and DASH score. CONCLUSIONS For patient function, range of motion, and pain, this investigation demonstrated that immobilization periods of 1 and 3 weeks produced superior short-term outcomes compared with those after 6 weeks of immobilization. These differences were not evident at 3 and 6 months following surgery, with the immobilization period having no significant effect on long-term function, range of motion, or pain. There were no significant differences in adverse events associated with shorter immobilization periods. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Narelle Watson
- Western Health, St. Albans, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | | | - Phong Tran
- Western Health, St. Albans, Victoria, Australia
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van Eck ME, Lameijer CM, El Moumni M. Structural validity of the Dutch version of the disability of arm, shoulder and hand questionnaire (DASH-DLV) in adult patients with hand and wrist injuries. BMC Musculoskelet Disord 2018; 19:207. [PMID: 29960600 PMCID: PMC6026503 DOI: 10.1186/s12891-018-2114-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 05/29/2018] [Indexed: 12/19/2022] Open
Abstract
Background Fractures of the hand and wrist are one of the most common injuries seen in adults. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire has been developed as a patient-reported assessment of pain and disability to evaluate the outcome after hand and wrist injuries. Patient reported outcomes (PROs) can be interpreted as pain, function or patient satisfaction. To be able to interpret clinical relevance of a PRO, the structural validity and internal consistency is tested. The Dutch version of the DASH has not yet been validated. The aim of this study was to evaluate the structural validity and the internal consistency of the existing Dutch version of the DASH. The relevance of reporting subscale scores was investigated. Methods This study was a retrospective analysis of cross-sectional data of 370 patients with an isolated hand or wrist injury. Adult patients aged 18 to 65 years treated conservatively or surgically were included. Patients unable to understand or read the Dutch language were excluded. Confirmatory factor analysis was used to investigate the structural validity, while Cronbach’s alpha and coefficient omega were used to assess internal consistency. Results All investigated models (a single factor model, a 3-correlated factor, and a bifactor model) were associated with a good model fit. Both the single factor and the 3-correlated factor model were associated with factor loadings of at least 0.70. In addition, the covariance between the factors in the 3-correlated factor model was positive (at least 0.89) and statistically significant (p < 0.001). In the bifactor model, the additional value of subscales was limited as the items loaded high on the general factor but low on the subscale factors. Conclusion This study indicates that the Dutch version of the DASH should be considered as an unidimensional trait. A single score should be reported.
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Affiliation(s)
- M E van Eck
- University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, The Netherlands
| | - C M Lameijer
- University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, The Netherlands
| | - M El Moumni
- University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, The Netherlands.
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Varghese VD, Smitham P, Howell S, Edwards S, Rickman M. POWIFF- Prospective study of wrist internal fixation of fracture: A protocol for a single centre, superiority, randomised controlled trial to study the efficacy of the VRP (2.0) distal radius plate (Austofix) versus the VA-LCP (Depuy-Synthes) for distal radius fractures. BMC Musculoskelet Disord 2018; 19:131. [PMID: 29712566 PMCID: PMC5928597 DOI: 10.1186/s12891-018-2052-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 04/23/2018] [Indexed: 01/02/2023] Open
Abstract
Background Distal radial fractures are one of the most common orthopaedic cases that present to the A&E department. Surgical intervention is warranted in displaced intraarticular fractures and fractures with more than the recommended angulation or shortening, and is most commonly treated with volarly placed fixed angle locking plates. The aim of this study is to determine and compare the efficacy of two different plates for surgical treatment of distal radius fractures. The VRP 2.0 is a new plate produced by the Austofix company and this system will be compared against the VA-LP (Variable angle-locking plate) produced by Depuy-Synthes which has been used as the standard treatment device. Methods and Design Patients between the ages of 18 and 80 presenting to the Royal Adelaide Hospital with isolated closed distal radial fractures will be invited to participate in this study. A total of 200 patients are required to provide 90% statistical power at a 5% alpha level to detect a difference of 11.5 points on the PRWE (Patient rated Wrist evaluation) score. The primary outcome measure will be the PRWE score while the secondary outcome measures will include the DASH score, EQ5D score, clinical range of movements, grip strength as well as patient perceived return of function at the wrist and time to resumption to work. These will be measured at 6 weeks, 3 months and 12 months. Radiographic indices including the radial tilt, length, volar inclination and plate prominence will also be measured. Complications will be recorded up to 12 months. Post hoc comparisons will be done using paired t tests. An intention to treat and a per protocol analysis will be done to compare the 2 groups. Discussion Distal radial fractures are increasingly being treated by internal fixation using volar locking plates. However, there is no prospective study to date comparing one plate against another in terms of outcome and complications. This study could provide more information about the best way to treat these injuries surgically. Trial registration The trial is registered with the Australia New Zealand Clinical Trials Registry (ANZCTR). Trial registration date-17/11/2016. Trial registration number-ACTRN12616001590459. Electronic supplementary material The online version of this article (10.1186/s12891-018-2052-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- V D Varghese
- Discipline of Orthopaedics and Trauma, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
| | - Peter Smitham
- Discipline of Orthopaedics and Trauma, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
| | - Stuart Howell
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Mark Rickman
- Discipline of Orthopaedics and Trauma, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
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Esakki S, MacDermid JC, Vincent JI, Packham TL, Walton D, Grewal R. Rasch analysis of the patient-rated wrist evaluation questionnaire. Arch Physiother 2018; 8:5. [PMID: 29497563 PMCID: PMC5828063 DOI: 10.1186/s40945-018-0046-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 02/08/2018] [Indexed: 11/13/2022] Open
Abstract
Background The Patient-Rated Wrist Evaluation (PRWE) was developed as a wrist joint specific measure of pain and disability and evidence of sound validity has been accumulated through classical psychometric methods. Rasch analysis (RA) has been endorsed as a newer method for analyzing the clinical measurement properties of self-report outcome measures. The purpose of this study was to evaluate the PRWE using Rasch modeling. Methods We employed the Rasch model to assess overall fit, response scaling, individual item fit, differential item functioning (DIF), local dependency, unidimensionality and person separation index (PSI). A convenience sample of 382 patients with distal radius fracture was recruited from the hand and upper limb clinic at large academic healthcare organization, London, Ontario, Canada, 6-month post-injury scores of the PRWE was used. RA was conducted on the 3 subscales (pain, specific activities, and usual activities) of the PRWE separately. Results The pain subscale adequately fit the Rasch model when item 4 “Pain - When it is at its worst” was deleted to eliminate non-uniform DIF by age group, and item 5 “How often do you have pain” was rescored by collapsing into 8 intervals to eliminate disordered thresholds. Uniform DIF for “Use my affected hand to push up from the chair” (by work status) and “Use bathroom tissue with my affected hand” (by injured hand) was addressed by splitting the items for analysis. After background rescoring of 2 items in pain subscale, 2 items in specific activities and 3 items in usual activities, all three subscales of the PRWE were well targeted and had high reliability (PSI = 0.86). These changes provided a unidimensional, interval-level scaled measure. Conclusion Like a previous analysis of the Patient-Rated Wrist and Hand Evaluation, this study found the PRWE could be fit to the Rasch model with rescoring of multiple items. However, the modifications required to achieve fit were not the same across studies, our fit statistics also suggested one of the pain items should be deleted. This study adds to the pool of evidence supporting the PRWE, but cannot confidently provide a Rasch-based scoring algorithm. Electronic supplementary material The online version of this article (10.1186/s40945-018-0046-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Saravanan Esakki
- 1School of Physical Therapy, Western University, London, ON Canada
| | - Joy C MacDermid
- 1School of Physical Therapy, Western University, London, ON Canada.,3The Hand and Upper Limb Centre, St Joseph's Health Centre, London, ON Canada
| | - Joshua I Vincent
- 1School of Physical Therapy, Western University, London, ON Canada
| | - Tara L Packham
- 2School of Rehabilitation Science, McMaster University, Hamilton, ON Canada
| | - David Walton
- 1School of Physical Therapy, Western University, London, ON Canada
| | - Ruby Grewal
- 3The Hand and Upper Limb Centre, St Joseph's Health Centre, London, ON Canada.,4Department of Surgery, University of Western Ontario, London, ON Canada
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Watson NJ, Martin SA, Keating JL. The impact of wrist fracture, surgical repair and immobilization on patients: a qualitative study. Clin Rehabil 2018; 32:841-851. [DOI: 10.1177/0269215518754614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Narelle J Watson
- Faculty Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Western Centre for Health Research & Education, Sunshine Hospital, St. Albans, VIC, Australia
| | - Sally A Martin
- Western Centre for Health Research & Education, Sunshine Hospital, St. Albans, VIC, Australia
| | - Jennifer L Keating
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Lameijer CM, ten Duis HJ, Vroling D, Hartlief MT, El Moumni M, van der Sluis CK. Prevalence of posttraumatic arthritis following distal radius fractures in non-osteoporotic patients and the association with radiological measurements, clinician and patient-reported outcomes. Arch Orthop Trauma Surg 2018; 138:1699-1712. [PMID: 30317380 PMCID: PMC6224009 DOI: 10.1007/s00402-018-3046-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Outcomes of non-osteoporotic patients who sustained a distal radius fracture (DRF) have not gained much attention in recent literature. The aims of this study were to determine the prevalence of posttraumatic arthritis (PA), to analyze associations of radiological measurements, clinician-reported and patient-reported outcomes (CROs and PROs) with PA and gain insight into employment changes after DRF in non-osteoporotic patients. METHODS Non-osteoporotic patients following a DRF were selected. Radiographs of both wrists were obtained at follow-up and the degree of PA was determined. Radiological measurements consisted of grading of PA, ulnar variance, radial length, radial inclination, dorsal tilt, distal radio-ulnar joint width, scapholunate dissociation, step-off and gap. Active range of motion and grip strength measurements were performed and all patients filled in four questionnaires to assess pain, upper extremity functioning, and health status (Disability of Arm, Shoulder and Hand; Patient Reported Wrist Evaluation; Michigan Hand Questionnaire; Short Form-36). RESULTS Seventy-three patients (32 women, 41 men) with a mean age of 33.5 (SD 9.2) years were included. Prevalence of PA was 32% at a median follow-up of 62.0 months. Patients with PA had statistically significant longer radial length (1.1 mm, 95% CI - 2.1; - 0.0, p = 0.045). Patients with PA had a statistically significant diminished flexion/extension arc of motion (12.0°, p = 0.008) and ulnar/radial deviation arc of motion (6.3°, p = 0.018). When corrected for dominance, all grip strength measurements were not statistically significantly different between patients with and without PA. Statistically significant poorer PROs in patients with PA were the MHQ subscales general functioning (65 versus 75, p = 0.018), esthetics (94 versus 100, p = 0.037), satisfaction (75 versus 92, p = 0.042) and total score of the MHQ (83 versus 91, p = 0.044), as well as the SF-36 subscale physical functioning (95 versus 100, p = 0.028). In regression analyses the DASH, PRWE function and PRWE total were statistically significantly associated with flexion/extension arc of motion. Seven patients (10%) changed or left their occupation because of the DRF. CONCLUSION Non-osteoporotic patients had a considerably high prevalence of PA following DRFs, despite a relatively short follow-up time. Patients with longer radial length more often had PA. Irrespective of AO/OTA fracture type, patients with PA had diminished range of motion, but no altered grip strength measurements. Non-osteoporotic patients following DRFs perceived diminished general functioning and dissatisfaction, which was impacted by the diminished active range of motion. Pain or impaired general health status was not reported. The PRO MHQ might be a valuable evaluation tool in this patient group. Change of occupation following DRFs should receive attention in further research.
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Affiliation(s)
- C. M. Lameijer
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Postbox 30.001, Huispostcode BA51, 9700 RB Groningen, The Netherlands
| | - H. J. ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Postbox 30.001, Huispostcode BA51, 9700 RB Groningen, The Netherlands
| | - D. Vroling
- Rehabilitation Center ‘Revalidatie Friesland’, Leeuwarden, The Netherlands
| | - M. T. Hartlief
- Rehabilitation Center ‘Revalidatie Friesland’, Leeuwarden, The Netherlands
| | - M. El Moumni
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Postbox 30.001, Huispostcode BA51, 9700 RB Groningen, The Netherlands
| | - C. K. van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Shefer Eini D, Ratzon NZ, Rizzo AA, Yeh SC, Lange B, Yaffe B, Daich A, Weiss PL, Kizony R. Camera-tracking gaming control device for evaluation of active wrist flexion and extension. J Hand Ther 2017; 30:89-96. [PMID: 27899222 DOI: 10.1016/j.jht.2016.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 07/06/2016] [Accepted: 07/11/2016] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Cross sectional. INTRODUCTION Measuring wrist range of motion (ROM) is an essential procedure in hand therapy clinics. PURPOSE OF THE STUDY To test the reliability and validity of a dynamic ROM assessment, the Camera Wrist Tracker (CWT). METHODS Wrist flexion and extension ROM of 15 patients with distal radius fractures and 15 matched controls were assessed with the CWT and with a universal goniometer. RESULTS One-way model intraclass correlation coefficient analysis indicated high test-retest reliability for extension (ICC = 0.92) and moderate reliability for flexion (ICC = 0.49). Standard error for extension was 2.45° and for flexion was 4.07°. Repeated-measures analysis revealed a significant main effect for group; ROM was greater in the control group (F[1, 28] = 47.35; P < .001). The concurrent validity of the CWT was partially supported. CONCLUSION The results indicate that the CWT may provide highly reliable scores for dynamic wrist extension ROM, and moderately reliable scores for flexion, in people recovering from a distal radius fracture. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Dalit Shefer Eini
- Department of Occupational Therapy, Stanley Steyer School of Health Professions Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Occupational Therapy, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Navah Z Ratzon
- Department of Occupational Therapy, Stanley Steyer School of Health Professions Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Albert A Rizzo
- Institute for Creative Technologies, University of Southern California, Los Angeles, CA, USA
| | - Shih-Ching Yeh
- School of Information Science and Technology, Fudan University, Shanghai, China
| | - Belinda Lange
- Institute for Creative Technologies, University of Southern California, Los Angeles, CA, USA
| | - Batia Yaffe
- Department of Hand Surgery, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Alexander Daich
- Department of Orthopedic Rehabilitation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Patrice L Weiss
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Rachel Kizony
- Department of Occupational Therapy, Chaim Sheba Medical Center, Ramat Gan, Israel; Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
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Kennedy CA, Beaton DE. A user's survey of the clinical application and content validity of the DASH (Disabilities of the Arm, Shoulder and Hand) outcome measure. J Hand Ther 2017; 30:30-40.e2. [PMID: 27469538 DOI: 10.1016/j.jht.2016.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/18/2016] [Accepted: 06/17/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Survey. PURPOSE OF THE STUDY To elicit feedback on the clinical use and content validity of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure from frontline users of the instrument. METHODS A cross-sectional survey was administered to registered DASH users and inquired about how the DASH was being used and to identify the informational value of items of the DASH (content validity). RESULTS About 172 completed the survey. One or both of the DASH and/or QuickDASH were consistently (89.5%) being used. About 90% were using it in adults (21-65 years), and at least 70% were using it across the entire extremity, and to a lesser extent, 10% reported using it in isolated neck injuries. Most respondents (66.9%-75.8%) were using the DASH in musculoskeletal (MSK) disorders, with some applying it for other more unique or non-MSK conditions (2.5%-16.6%). All but 1 of the 30 DASH items had at least 10% endorsement as being informative, and 4 items were identified as being problematic by greater than 20%. CONCLUSIONS The DASH is being used as intended (whole extremity and MSK conditions), and in addition, it is being used in different body regions and diverse conditions. LEVEL OF EVIDENCE Not applicable (descriptive survey).
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Affiliation(s)
- Carol A Kennedy
- Institute for Work & Health, Toronto, Ontario, Canada; Mobility Program, Musculoskeletal Health & Outcomes Research, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Dorcas E Beaton
- Institute for Work & Health, Toronto, Ontario, Canada; Mobility Program, Musculoskeletal Health & Outcomes Research, St. Michael's Hospital, Toronto, Ontario, Canada
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Abstract
Patient reported outcome measures (PROMs) are key tools when performing clinical research and PROM data are increasingly used to inform clinical decision-making, patient-centered care, health policy and more recently, reimbursement decisions. PROMs must possess particular properties before they are used. Thus purpose of this paper is to give an overview of PROMs, their definition, how their evidence can be assessed, how they should be reported in clinical research, how to choose PROMs, the types of PROMs available in orthopaedics, where these measures can be found, PROMs in orthopaedic clinical practice and what are some key next steps in this field. If PROMs are used in accordance with the guidance in this article, I believe we will gain considerable insight into PROMs in orthopaedics and will advance this field in a way that can contribute to science, improve patient care and save considerable resources. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2098-2108, 2017.
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Affiliation(s)
- Joel J Gagnier
- Department of Orthopaedic Surgery, University of Michigan Health System, MedSport, Domino's Farms, 24 Frank Lloyd Wright Drive, 48105 Ann Arbor, Michigan.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Williamson PR, Altman DG, Bagley H, Barnes KL, Blazeby JM, Brookes ST, Clarke M, Gargon E, Gorst S, Harman N, Kirkham JJ, McNair A, Prinsen CAC, Schmitt J, Terwee CB, Young B. The COMET Handbook: version 1.0. Trials 2017; 18:280. [PMID: 28681707 PMCID: PMC5499094 DOI: 10.1186/s13063-017-1978-4] [Citation(s) in RCA: 1023] [Impact Index Per Article: 146.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The selection of appropriate outcomes is crucial when designing clinical trials in order to compare the effects of different interventions directly. For the findings to influence policy and practice, the outcomes need to be relevant and important to key stakeholders including patients and the public, health care professionals and others making decisions about health care. It is now widely acknowledged that insufficient attention has been paid to the choice of outcomes measured in clinical trials. Researchers are increasingly addressing this issue through the development and use of a core outcome set, an agreed standardised collection of outcomes which should be measured and reported, as a minimum, in all trials for a specific clinical area.Accumulating work in this area has identified the need for guidance on the development, implementation, evaluation and updating of core outcome sets. This Handbook, developed by the COMET Initiative, brings together current thinking and methodological research regarding those issues. We recommend a four-step process to develop a core outcome set. The aim is to update the contents of the Handbook as further research is identified.
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Affiliation(s)
- Paula R. Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Douglas G. Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Heather Bagley
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Karen L. Barnes
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Jane M. Blazeby
- MRC ConDuCT II Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sara T. Brookes
- MRC ConDuCT II Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mike Clarke
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- National University of Ireland Galway and HRB Trials Methodology Research Network, Galway, Ireland
| | - Elizabeth Gargon
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Sarah Gorst
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Nicola Harman
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Jamie J. Kirkham
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Angus McNair
- MRC ConDuCT II Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Cecilia A. C. Prinsen
- Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, Medizinische Fakultät, Technische Univesität Dresden, Dresden, Germany
| | - Caroline B. Terwee
- Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Bridget Young
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
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